Obstetric Cholestasis

Question 1

Obstetric Cholestasis

Answer 1

Intrahepatic cholestasis of pregnancy due to reduced outflow of bile acids from the liver

Question 2

When does obstetric cholestasis usually develop

Answer 2

Develops later in pregnancy (i.e. after 28 weeks)

Question 3

Risk of obstetric cholestasis

Answer 3

Stillbirth

Question 4

Presentation of obstetric cholestasis

Answer 4

Pruritis affecting the palms of the hands and soles of the feet

Other symptoms:

• Fatigue
• Dark urine
• Pale, greasy stools
• Jaundice

Question 5

Differential diagnosis for obstetric cholestasis

Answer 5

Pemphigoid gestationis - rash
Polymorphic eruption of pregnancy - rash

Gallstones
Acute fatty liver disease
Autoimmune hepatitis
Viral hepatitis

Question 6

Investigations for obstetric cholestasis

Answer 6

Abdominal examination 
Bloods
- FBC 
- LFTs
- U+Es 
- Bile acids

Question 7

Obstetric cholestasis LFT results

Answer 7

High ALT, AST and GGT
Raised bile acids
(ALP raised due to pregnancy)
Prothrombin time

Question 8

Management of obstetric cholestasis

Answer 8

Ursodeoxycholic acid

Symptomatic treatment:

• Emollients (i.e. calamine lotion) to soothe the skin
• Antihistamines (e.g. chlorphenamine) can help sleeping (but does not improve itching)

Water soluble vitamin K - if prothrombin time is deranged

Planned delivery after 37 weeks may be considered

Question 9

Obstetric cholestasis monitoring

Answer 9

Monitor LFTs weekly and after pregnancy (at least 10 days after)