Obstetric cholestasis rash: what to know

Obstetric cholestasis, also called intrahepatic cholestasis of pregnancy, is a liver-related condition. Bile acids build up in the blood and may irritate the skin, causing itching on the hands, feet, arms, or elsewhere. The itching may be worse at night. A visible rash is not required; scratched skin can develop redness or marks that look like a rash.

Itching in pregnancy has many possible explanations, including dry skin and other skin conditions. The symptom alone cannot identify its cause, so maternity assessment matters even when the skin looks normal.

Contact your midwife, obstetric team, or maternity unit promptly if new or persistent itching develops. They may arrange blood tests that check bile acids and liver function, then repeat them if symptoms continue because results can change over time.

Until you receive advice, keep the skin cool, use unperfumed moisturiser, wear loose cotton clothing, and avoid hot baths. Do not start medicines or herbal products for itching without checking that they are suitable in pregnancy. Your team may discuss monitoring, treatment, and a birth plan based on your symptoms, test results, and stage of pregnancy.

Seek urgent maternity advice if itching is severe, suddenly worsens, or is accompanied by yellowing of the eyes or skin, dark urine, pale stools, right upper abdominal pain, or feeling markedly unwell. Contact your maternity unit immediately for reduced or changed fetal movements, vaginal bleeding, painful contractions, or fluid loss. These warning signs need assessment regardless of whether a rash is visible.

Ask which blood tests you need, when results will be reviewed, whether testing should be repeated, and how fetal wellbeing will be monitored. You can also ask what symptoms should trigger an immediate call and how a possible birth plan may change. If induction is discussed, read about Induction of Labour.