Antenatal - OC Flashcards
what is obstetric cholestasis (aka intrahepatic cholestasis of pregnancy)
reduced outflow of bile acids from the liver which resolves after delivery of the baby.
bile acids are produced in the liver from the breakdown of cholesterol and they flow from the liver to the hepatic ducts past the gallbladder and out of the bile duct into the intestines. the outflow is reduced and causes them to build up in the blood = pruritus
when does obstetric cholestasis usually develop?
later in pregnancy usually after 28 weeks
obstetric cholestasis is associated with increased risk fo what?
stillbirth
how does obstetric cholestasis present?
itching - palms and soles of feet
fatigue
dark urine
pale, greasy stools
jaundice
NO RASH
name 2 alternative dx for obstetric cholestasis if there is a rash present?
polymorphic eruption of pregnancy
pemphigoid gestationis
what are some other causes of deranged LFTs that should be excluded when obstetric cholestasis is suspected?
gallstones
acute fatty liver
autoimmune hepatitis
viral hepatitis
what tests need to be done and what are the results in obstetric cholestasis?
LFT - abnormal ALT, AST and GGT
Raised bile acids
(placenta produces ALP - rise in ALP without other abnormal LFT results is usually due to placental production of ALP, rather than liver pathology)
how is obstetric cholestasis managed?
- ursodeoxycholic acid - improves LFTs, bile salts and symptoms
- itching - emollients
- to help with sleep - antihistamines
- monitor LFTs weekly during pregnancy and 10 days after delivery
- planned delivery at 37 weeks may be considered particularly when LFTs and bile acids are severely deranged
what needs to be given if clotting is deranged?
water-soluble vitamin K - bile acids are important for absorption of fat-soluble vitamins in intestines so lack of bile acids can lead to vit K deficiency - vit K needed for clotting
