Obstetric_Cholestasis_Flashcards
What is the antenatal management for obstetric cholestasis?
All women should have consultant-led antenatal care and be advised to give birth on a labour ward. Weekly LFTs (including bile acid concentration) until delivery.
What monitoring is required for women with obstetric cholestasis?
Weekly LFTs (including bile acid concentration) until delivery. No specific fetal monitoring is recommended, but advise women to pay close attention to fetal movements and present for immediate assessment if concerned.
What symptom management options are available for obstetric cholestasis?
Conservative measures (cool, loose clothing, cool baths, ice packs), topical emollients (Menthol 0.5% with aqueous cream), sedating antihistamines (e.g., chlorphenamine), ursodeoxycholic acid for pruritus, and oral vitamin K if evidence of reduced fat absorption or prolonged prothrombin time.
What are the recommendations for delivery based on serum bile acid concentration in obstetric cholestasis?
If serum bile acid concentration 19-39μmol/L, discuss delivery options by 40 weeks’ gestation. If 40-99μmol/L, consider planned birth at 38-39 weeks’ gestation. If ≥100μmol/L, advise planned birth at 35-36 weeks’ gestation. Offer immediate delivery if beyond 35 weeks’ gestation and bile acid concentration ≥100μmol/L.
What postnatal management is required for obstetric cholestasis?
Confirm diagnosis at follow-up at least 4 weeks postpartum by checking the resolution of itching and LFTs (including bile acids).
