Sponsors

You're browsing as an anonymous user. Join the community today to view notes at your university, edit pages, and share knowledge!

Obstetric Cholestasis

From Mediwikis

Introduction

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

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
  • Anorexia
  • Malaise

Aetiology

Itch caused by build up of bile salts in blood due to oestrogen impaired metabolism of bile acids.

Investigations

  • Liver Ultrasound Scan
  • Viral Serology
  • Liver autoantibodies(antimitochondrial, anti-smooth muscle)

Management

  • 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

Complications

  • 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