cholestasis of pregnancy Flashcards
What proportion of pregnancies are impacted by intrahepatic cholestasis of pregnancy (aka obstetric cholestasis)? What proportion of Indian-Asian or Pakistani-asian pts?
0.7%, 1.2-1.5%
What is obstetric cholestasis?
A multifactorial condition of pregnancy characterised by pruritis in the absence of a skin rash with abnormal LFTs &/or bile acids, neither of which has an alternative cause & both of which resolve after birth
what’s the clinical importance of obstetric cholestasis?
foetal risks, including passage of meconium, preterm birth (particularly iatrogenic, spontaneous preterm birth only slightly increased cf general population), foetal distress & foetal death
Maternal morbidity due to intense pruritis & sleep deprivation, increased risk of PPH
Increased risk delivery by LSCS
Pruritis of what pattern & which body sites is particularly suggestive of obstetric cholestasis?
worse @ night. palms & soles of the feet
What are some other signs of cholestasis aside from itch?
pale stool, dark urine, jaundice
What are some risk factors for obstetric cholestasis?
PHx obstetric cholestasis, multiple pregnancy, Hx hepatitis C, gallstones
What’s the usual explanation for elevated ALP in pregnancy?
It’s usually of placental origin
What’s the normal upper limit of normal for transaminases, GGT & bilirubin throughout pregnancy?
20% lower than the non-pregnant range
What are some differentials for pruritis & abnormal LFTs aside from obstetric cholestasis?
PET, acute fatty liver of pregnancy
Hep A/B/C, EBV, CMV, PBC
Which antibodies may be positive if the pt has primary biliary cirrhosis?
anti-smooth muscle & antimitochondrial
How long after delivery should LFT check (to confirm resolution of abnormalities which would be consistent with obstetric cholestasis) be performed? Why?
10 days, since LFTs may increase in the first 10 days postnatally in a normal pregnancy.
What’s the cutoff level for bile acids level in severe cholestasis? what level is considered mild?
> 40micromoles/L
bile acids <20micromoles/L
When should vitamin K be used?
If prothrombin time is prolonged, in doses of 5-10mg/day
Why may women with obstetric cholestasis have vit K deficiency?
Vit K is a fat-soluble vitamin so women with fat malabsorption, especially due to biliary obstruction or hepatic disease, may become deficient in vitamin K due to lack of excretion of bile salts into the GIT & reduced micelle formation
