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A - MSRA Obstetrics [16] > [15] Obstetric Cholestasis > Flashcards

[15] Obstetric Cholestasis Flashcards

1
Q

What is obstetric cholestasis characterised by?

A
  • Abnormal LFTs

- Intense pruritis in absence of skin rash

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2
Q

What LFTs in particular are abnormal in obstetric cholestasis?

A

AST and ALT elevation

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3
Q

What happens to the abnormal LFTs after delivery in obstetric cholestasis?

A

They resolve after delivery

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4
Q

What % of pregnancies are affected by obstetric cholestasis?

A

0.7%

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5
Q

What is the underlying cause of obstetric cholestasis?

A

Underlying cause not known, but likely to be a combination of genetic and environmental factors

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6
Q

What are the risk factors for obstetric cholestasis?

A
  • Past history of OC
  • Family history of OC
  • Multiple pregnancy
  • Presence of gallstones
  • Hep C
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7
Q

When does OC typically present?

A

3rd trimester

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8
Q

How does OC present?

A

Intense pruritis

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9
Q

What part of the body is affected in OC?

A

Can affect any part of the body, but particularly the palms of hands and soles of feet

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10
Q

Why can OC be difficult to diagnose?

A

Because pruritis is common in pregnancy, and only a minority will have OC

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11
Q

Describe the pattern of symptoms in OC

A

They are worse at night

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12
Q

What is the result of the symptoms of OC being worse at night?

A

May interfere with sleep

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13
Q

What signs might a women with OC develop?

A
  • Dark stool
  • Dark urine
  • Jaundice
  • Generalised malaise and fatigue
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14
Q

What are the differential diagnoses of OC?

A
  • Hyperemesis gravidum
  • Pre-eclampsia
  • HELLP syndrome
  • Chronic liver disease
  • Gallstones
  • EBV
  • Medications
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15
Q

What chronic liver diseases are differentials for OC?

A
  • Cholestatic liver disease
  • Acute fatty liver of pregnancy
  • Autoimmune hepatitis
  • Viral hepatitis
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16
Q

How is a diagnosis of OC be made?

A

If no other cause is found, a diagnosis can be based on symptoms and LFT abnormalities

17
Q

What pattern of LFTs is typical with OC?

A

Raised transaminases and gamma-GT, bilirubin sometimes raised

18
Q

What needs to be considered when interpreting LFTs to diagnose OC?

A

Interpretation should be made in light of pregnancy specific ranges

19
Q

How does pregnancy change the ranges of LFTs?

A

The upper limit of normal is 20% lower than non-pregnant levels throughout pregnancy

20
Q

What needs to be excluded when making a diagnosis of OC?

A

Other clinical conditions that affect the liver in pregnancy

21
Q

What investigations may be done to exclude other conditions that affect the liver in pregnancy?

A
  • Liver ultrasound scan
  • Measurement of BP
  • Further blood tests
22
Q

What monitoring should be done in OC?

A

LFTs should be monitored weekly

23
Q

What is being looked for when monitoring LFTs in OC?

A

To see if they return to normal or soar into the 100’s

24
Q

What should be done if LFTs return to normal or soar into the 100’s in OC?

A

The diagnosis should be revised

25
Q

When should LFTs be checked following delivery in OC?

A

Wait at least 10 days before re-checking

26
Q

Why should you wait at least 10 days before re-checking LFTs after delivery in OC?

A

To avoid the confounding factor of normal fluctuations in LFTs during this time following normal pregnancy

27
Q

What is the mainstay of medical management in OC?

A

Ursodeoxycholic acid (UDCA)

28
Q

Why is UDCA used in OC?

A

Because it has positive effects on maternal and fetal outcomes, and on pruritis

29
Q

What is the role of topical emollients in OC?

A

They are safe for the mother and baby, but of unknown efficacy

30
Q

Describe the role of vitamin K in OC?

A

It may be offered, particularly if there is steatorrhoea or prolonged prothrombin time

31
Q

At what point should induction of labour be considered in OC?

A

37 weeks onwards

32
Q

Why should induction of labour be considered at 37 weeks onwards in OC?

A

Because perinatal and maternal mortality are increased from this point

33
Q

When in particular is maternal and perinatal mortality increased from 37 weeks onwards in OC?

A

In those with more severe disease and higher levels of transaminases and bile acids

34
Q

What are the complications of OC?

A
  • Increased risk of feta distress and intrauterine death
  • Increased risk of premature birth (spontaneous and iatrogenic)
  • Maternal morbidity due to intense itching and lack of sleep

A - MSRA Obstetrics [16] (61 decks)

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