8A) Antenatal Care: Obstetric cholestasis Flashcards
Incidence of OC
0.7% of pregnancies (1.2-1.5% of Indian/Pakistani population)
Incidence of pruritus in pregnancy
23%
How often to repeat LFTs if symptoms persist but bloods normal?
Every 1-2 weeks
When to check LFTs postnatal?
Defer at least 10 days (can usually be done at 6w PN check)
How often to repeat LFTs once OC diagnosis confirmed?
Weekly
Monitoring in labour
Continuous CTG
Risks of OC
- ?Stillbirth
- Preterm birth (mostly iatrogenic)
- Increased passage of meconium
How can outcome in OC be predicted?
Can’t be predicted by biochemical results, USS or CTG.
When to deliver with OC?
Discussion re: IOL from 37 weeks.
Recurrence rate of OC
45-90%
Treatment for OC
Topical emollients - safe but may not be effective.
Chlorphenamine - sedation but doesn’t affect pruritus.
URSO - improves pruritus and LFTs.
Vitamin K (5-10mg daily) if PT prolonged.
Not in use:
Colestyramine
SAME
Dexamethasone
Risk factors of obstetric cholestasis
Multiple pregnancy IVF Older women Hx of gallstones or hep C Sisters of affected women Oral progesterone for PTB prevention Low selenium and vitamin D intake
What percentage of cases of OC can be explained by known genetic variation?
10-15% (mutations in bile acid receptor FXR or transport proteins)
What percentage of women present after 30 weeks?
80%
What percentage of women get jaundice?
<10%
