Minor Problems of Pregnancy

Question 1

What is obstetric cholestasis also known as?

Answer 1

Intrahepatic cholestasis of pregnancy

More common in Asian women.

Question 2

During which trimester of pregnancy does obstetric cholestasis typically present?

Answer 2

3rd trimester

Symptoms may include pruritus and abnormal liver function tests.

Question 3

What are the main symptoms of obstetric cholestasis?

Answer 3

• Pruritus (without skin rash) mainly in soles and palms, worse at night
• Reduced fetal movement
• Abnormal LFTs without alternative cause
• Anorexia and malaise
• Epigastric discomfort, steatorrhoea, and dark urine (less common)
• Resolves after birth

Question 4

What are some risk factors for obstetric cholestasis?

Answer 4

• Personal or family history of obstetric cholestasis
• History of liver disease
• Multiple gestation

Question 5

How is obstetric cholestasis diagnosed?

Answer 5

Diagnosis of exclusion

Requires full history and examination, abnormal LFTs, and elevated bile acids without hepatic dysfunction.

Question 6

What are some differential diagnoses for obstetric cholestasis?

Answer 6

• Obstructive jaundice – gallstones
• Acute and chronic viral hepatitis
• Autoimmune liver disease, e.g. PBC, AIH

Question 7

What investigations are recommended for obstetric cholestasis?

Answer 7

• Bloods: LFTs, bilirubin, clotting, viral serology (hep, CMV, EBV), autoimmune screen (AMA and ASMA)
• Imaging: Ultrasound abdomen – liver

Question 8

What are some maternal complications associated with obstetric cholestasis?

Answer 8

• Vitamin K deficiency → risk of postpartum hemorrhage
• Intense pruritus → maternal sleep deprivation

Question 9

What are some fetal complications associated with obstetric cholestasis?

Answer 9

• Preterm birth – spontaneous and iatrogenic
• Increased risk of meconium
• Fetal distress
• Intracranial hemorrhage
• Intrauterine death

Question 10

What is the recommended management for obstetric cholestasis during antenatal care?

Answer 10

• Consultant-led care
• Induction of labor at 37 weeks
• Topical emollients
• Antihistamine
• Ursodeoxycholic acid
• Vitamin K

Question 11

What is the purpose of continuous CTG during labor in cases of obstetric cholestasis?

Answer 11

To monitor fetal heart rate and well-being

Helps detect any signs of fetal distress.

Question 12

What should be checked postpartum in cases of obstetric cholestasis?

Answer 12

Symptoms and liver function tests to ensure resolution

Important for maternal health.