Obstetric Cholestasis

Question 1

What is obstetric cholestasis?

Answer 1

Condition of the liver with reduced flow of bile down the ducts and leakage of some bile salts into the bloodstream due to abnormal cholestatic effect of oestrogens

Question 2

Clinically when would OC be diagnosed?

Answer 2

Diagnosis of exclusion -

Abnormal liver function tests W/O rash

Question 3

What are the signs and symptoms of OC?

Answer 3

Severe itching typically occuring (24wks+)
Typically occurring on the palms and soles
Progressively worse until delivery of foetus
Signs - NO rash however O/E excoriations may be present

Question 4

Name four risk factors associated with OC?

Answer 4

Multiple pregnancy
Ethnicity
Previous OC
Family Hx

Question 5

Name 3 foetal complications associated with OC?

Answer 5

Still birth
Pre-term delivery
Distressed labour/Meconium stained liquor

Question 6

Name 5 components within LFTs?

Answer 6

ALK (placenta produces this so may be raised)
ALT
VGT - gamma GT raised with alcohol
Bile acids
Serum billiruben

Question 7

Describe the management of OC?

Answer 7

Due to risk of messed up co-ag screen = Vit-K 10mg/day
UDCA helps alleviate symptoms by decreasing bile acid pool
Chlorphenamine helps with itch