Obstetric Cholestasis

Question 1

What is the definition of obstetric cholestasis?

Answer 1

Hepatobiliary disorder manifesting after 24th week of gestation, causing reduced outflow of bile acids from the liver which resolves after delivery of the baby.

Question 2

What causes obstetric cholestasis?

Answer 2

Underlying cause not known but thought to be increased oestrogen and progesterone levels
Genetic component

Question 3

What are some risk factors for obstetric cholestasis?

Answer 3

South Asian ethnicity
Past personal/family history of obstetric cholestasis
Multiple pregnancy
Presence of gallstones
Hep. C

Question 4

What are some clinical features of obstetric cholestasis?

Answer 4

Pruritus (particularly hands and feed)
General discomfort (fatigue or malaise)
GI symptoms (nausea and loss of appetite)
Jaundice (dark urine and pale stools)
Abdominal pain (RUQ)

Usually develops later in pregnancy, particularly third trimester

Question 5

What are some investigations for obstetric cholestasis?

Answer 5

Bloods:
- Abnormal LFTs (mainly ALT, AST and GGT)
- Raised bile acids

Rule out other causes:
- Liver USS
- Viral serology
- Liver autoantibodies

Question 6

What is the management of obstetric cholestasis?

Answer 6

Ursodeoxycholic acid: impoves LFTs, bile acids and symptoms
Emollients and antihistamines: helps itching
Water-soluble vitamin K: for PT derangement

Weekly monitoring of LFTs during pregnancy and at least 10 days after delivery

Planned delivery after 37 weeks may be considered

Question 7

What are some complications of obstetric cholestasis?

Answer 7

Increased risk of foetal distress at term
Amniotic fluid meconium aspiration
Intrauterine foetal death
Need for preterm delivery (and associated risks)