Obstetric cholestasis

Question 1

Risk factors

Answer 1

Previous history
Family history
Multiple pregnancy
Gallstones
Hepatitis C

Question 2

Clinical features

Answer 2

Usually 3rd trimester
Itch - especially hands and feet
No rash
Worse at night
Abnormal LFTs - no other cause found (do a liver screen)
(may be other signs of jaundice, generalised malaise/fatigue)

Question 3

Complications

Answer 3

Stillbirth
Fetal distress (meconium passage)
Preterm delivery
Haemorrhage (maternal and foetal)

Question 4

Management

Answer 4

Weekly LFTs during remainder of preganacy (if they return to normal or skyrocket, it's not OC)
Vit K (haemorrhage risk)
Ursodeoxyxxholic acid (itch, risk reduction)
Induction of labour around 38 weeks
Six week follow up to ensure LFTs returned to normal