Obstetric Cholestasis Flashcards
What is the function of the liver?
- Synthesis and storage of amino acids, proteins, vitamins and fats
- Bile production
- Blood circulation and filtration
- Blood glucose regulation
Where is bile stored?
Gall bladder
What is the function of bile?
Travels to the ileum to aid absorption of fat
What effect does progesterone have on the gall bladder?
- Makes it hypotonic (muscle relaxant)
- Increased bile storage
- Rate of emptying slows
- Bile becomes more diluted
What effect does pregnancy have on the liver?
- Increased bile production
- Displaced by the uterus
- Increased albumin levels
What is the other name for obstetric cholestasis?
Intrahepatic Cholestasis in Pregnancy (ICP)
What are some possible causes of OC?
- Sensitivity to oestrogen
- Accumulation of bile salts
- Coagulation disturbed
- Disturbance of hepatic circulation
What are some signs and symptoms of OC?
- Excessive itching
- Epigastric pain
- Mild jaundice
- Pale stools/ dark urine
- N+V
What is specific about OC itching?
- Not accompanied with rash
- Often worse at night
- Just on abdomen unlikely to be OC
What are the maternal complications associated with OC?
- Gallstones
- PPH (disturbed clotting)
- Emotional wellbeing declines
What are the foetal complications associated with OC?
- Preterm labour
- Foetal distress
- Stillbirth
- Haemorrhagic disease
What blood results would suggest that OC is the diagnosis?
Raised:
- Alkaline phosphate
- Bile acids
- Liver enzymes
- Bilirubin
What is the midwifery management for OC?
- Refer to consultant
- Advise cool baths and loose clothing
- Weekly bloods and CTG
- Active 3rd stage
What is the medical management for OC?
- Aqueous cream to soothe itching
- Piriton/ Ursodeoxycholic acid/ vitamin K
What does AFLP stand for?
Acute Fatty Liver of Pregnancy
