Obstetric cholestasis Flashcards
What is obstetric cholestasis?
Intrahepatic. Reduced outflow of bile acids from liver
When does obstetric cholestasis occur?
Later in pregnancy eg After 28 weeks, esp in 3rd trimester
Resolves after delivery
What causes obstetric cholestasis?
Increased oestrogen and progesterone levels
Genetics
South asian ethnicity
What is obs cholestasis increase risk of
stillbirth
Symptoms of obs cholestasis
Main - pruritis
Fatigue
Dark urine
Steatorrhea
Jaundice
NO RASH
Where does itching mainly affect in obs cholestasis?
Palms hands and soles of feet
Differentials other than obs cholestasis if rash present
Polymorphic eruption of pregnancy
Pemphigoid gestationis
Other causes of pruritis/ deranged LFTs
Gallstones
Acute fatty liver
AI hepatitis
Viral hepatitis
Investigations for obstetric cholestasis
LFTs + bile acids (increased)
What is a normal finding in LFTs in pregnancy?
Raised ALP - placenta prodyces ALP
Primary treatment for obstetric cholestasis
Ursodeoxycholic acid
How does ursodeoxycholic acid work
Facilitates bile flow through liver protecting liver cells
Reduces biliary cholesterol
How can pruritis be managed?
Emllients eg camomile lotion
Antihistamines eg chlorphenamine - sleep
When do yuo give water soluble vitamin K in obstetric cholestatsis?
When prothrombin time deranges
Why give water soluble vit K?
Bile acids necessary for absorption of vit K - lack bile acids -> vit K deficiency -> impaired clotting
