A common complaint of pregnancy, usually presenting in the 3rd trimester. It is characterised by a rash-less itching of the hands and feet with abnormal LFTs. It is a diagnosis of exclusion must rule out pre-eclampsia, hepatitis and gallstones using USS and blood tests first.
Symptoms can arise before the abnormal LFTs appear, so measure them weekly if obstetric cholestasis is suspected.
- Itching of hands and feet (without a rash)
- Abnormal LFTs- Raised ALT, ALP, Serum Bile Acid
- Dark urine
- Pale stools
Itch caused by build up of bile salts in blood due to oestrogen impaired metabolism of bile acids.
- Liver Ultrasound Scan
- Viral Serology
- Liver autoantibodies(antimitochondrial, anti-smooth muscle)
- Regular LFT and clotting screen
- Ursodeoxycholic acid (treats itching)
- Vitamin K at 32 weeks (prevents post partum haemorrhage, as mothers have decreased clotting with obstetric cholestasis)
- Labour induced at 37-38wks gestation, regardless of whether LFTs return to normal
- Low levels of Vitamin K- Post Partum Haemorrhage
- Increased risk of still birth (thought to be caused by fetal fibrillation)
- Increased risk of premature labour