Obstetric Choleostasis

Question 1

What are OC signs and symptoms?

Answer 1

• Generalised severe pruritus due to bile acids building up under the skin due to impaired liver function
• No rash
• Onset usually 3rd trimester
• Abnormal LFTs ( bile acids + ALT most sensitive) due to the liver being unable to cope with his levels of sex steroid
• Dark urine due to reflux of unconjugated bilirubin in the blood which is then excreted in the urine
• pale stools, malabsorption
• Anorexia, malaise

Question 2

What is OC pathogenesis?

Answer 2

OC occurs due to client having an increased genetic sensitivity to the cholestatic effects of oestrogen

Question 3

Name the OC investigations

Answer 3

• LFTs
• Clotting
• PET bloods
• Liver US scan
• Hep A, B, C
• Autoantibodies

Question 4

Name OC diagnosis

Answer 4

• Raised transaminases
• Bile acids if LFTs normal
• LFTs should be requested on any woman with pruritus without a rash

Question 5

What are the maternal complications associated with OC?

Answer 5

• Vitamin K deficiency caused by malabsorption of fat soluble vitamins which can potentially lead to PPH
• Sleep deprivation due to sever pruritus
• Severe liver impairment

Question 6

What are the metal complications associated with OC?

Answer 6

• Fetal compromise before or during labour
  . Mec staining - BA stimulate bowel activity
• Preterm labour
  . In OC myometrium more sensitive to oxytocin
  . BA stimulate prostaglandins
• IUD
  . BA cause dose dependant vasoconstriction of placental chorionic veins in vitro
  . BA toxic to cardiac myocytes

Question 7

What is the management of OC?

Answer 7

• Counsel mother re possible risks
• Monitor LFTs, clotting times, bile acids
• Fetal surveillance (growth, dopplers, CTG)
• Elective early delivery (37-38 weeks)
• Vit K 10mg daily
• Drug therapy
  . Antihistamines
  . Cholestyramine
  . UCDA (hydrophilic BA that replaces endogenous BA)
• Symptomatic relief
  . Emollients
  . Antihistamines