Obstetric cholestasis Flashcards
What is obstetric cholestasis?
The reduced flow of bile acids from the liver during pregnancy
When does obstetric cholestasis develop during pregnancy?
After 28 weeks
What is the aetiology of obstetric cholestasis?
The outflow of bile acids from the liver is reduced - this causes bile acids to build up in the blood resulting in itching
What is the presentation of obstetric cholestasis?
Pruritis - specifically of the hands and soles of the feet
Fatigue
Dark urine
Pale, greasy stools
Jaundice
No rash present
What are the differentials of obstetric cholestasis?
Gallstones
Acute fatty liver
Autoimmune hepatitis
Viral hepatitis
What investigations should be performed to diagnose obstetric cholestasis and what would they show?
LFTs - raised ALT, AST and GGT
Bile acids - raised
What is the main treatment of obstetric cholestasis?
Ursodeoxycholic acid
What other treatments might be useful in obstetric cholestasis?
Antihistamines to reduce itching
Emollients
What monitoring is required in patients with obstetric cholestasis?
Weekly LFTs during pregnancy and after delivery
When should delivery be planned in patients with obstetric cholestasis?
37 weeks
