Obstetric Cholestasis Flashcards
Define obstetric cholestasis.
Prutitus in pregnancy, which resolves at delivery, associated with abnormal liver function in the absence of other identifiable pathology.
Explain the aetiology of obstetric cholestasis.
Complex, likely genetic and hormonal factors
What are the risk factors for obstetric cholestasis?
PMHx
FHx
Ethnicity (asian)
Multiple pregnancy
Summarise the epidemiology of obstetric cholestasis in pregnancy.
UK prevalence 0.7%
What are the symptoms of obstetric cholestasis?
Generalised pruritus with no rash, worse at night, may be more intense over palms and soles
Rarely dark urine/steathorrea
What are some signs of obstetric cholestasis?
Excoriation marks
What investigations should be performed for obstetric cholestasis?
Bloods: LFT (high transaminases, may have high BR) bile acid (raised) clotting (may be abnormal due to low VitK absorption).
Diagnosis of exclusion: Therefore need to PET screen (FBC, U+Es, LFT, clotting), liver USS, hepatitis serology (A/B/C/E) EBV and CMV serology, liver antibodies (ANA, antiSMA)
What is the management for obstetric cholstasis?
Monitor: Weekly LFT, clotting, serial USS for fetal or intermittent CTG monitoring
Medication: Chlorpheniramine (control prutirus) ursodeoxycolic acid (decrease serum bile acids and pruritus, no effect in fetal compromise) VitK (reduce risk of fetal and maternal haemorrge) dexamethasone (if no response to UCDA)
Delivery: Induce at 37/40, increased risk of fetal death
Postpartum ensure resolution of abnormal LFTs after 10/7 postpartum.
What are some complications associated with obstetric cholestasis? What is the prognosis for obstetric cholestasis?
Maternal PPH due to low VitK
Baby HODN due to low bi K, intracranial haemorrage, fetal distress, preterm
Complete recovery postnatally, but 90% recurence in future pregnancies. Risk of fetal death 2-3%.
