OC

Question 1

Incidence (overall and ethnicity)

Answer 1

0.7%

Indian or Pakistani Asian 1.2-1.5%

Question 2

Definition of OC

Answer 2

Multifactorial condition of pregnancy characterized by pruritic in the absence of a skin rash with abnormal LFTs, neither of which has an alternative cause and both which resolve after birth

Question 3

Fetal risks

Answer 3

Spontaneous preterm birth
Iatrogenic preterm birth
Fetal death
Meconium passage

Maternal risk - sleep deprivation secondary to itch

Question 4

Diagnosis

Answer 4

Itch
Abnormal LFTS and/or
Raised bile acids

Question 5

Other symptoms

Answer 5

Pale stool
Dark urine
Jaundice
RUQ pain

Question 6

Risk factors

Answer 6

Personal hx
Fam hx
Multiple pregnancy
Hep C +
Known gallstones
IVF
Older women
Low selenium 
Low vitamin D

Question 7

Persistent unexplained itch and normal biochem - how often test?

Answer 7

Every 1-2 weeks

Question 8

Tests for other causes

Answer 8

Viral screen: hep a,b,c, EBV, CMV
Liver autoimmune screen (anti-smooth muscle and anti mitochondrial antibodies)
Liver USS

Question 9

Perinatal mortality rate

Answer 9

5.7/1000

Question 10

Mechanism of action of UDCA

Answer 10

Improves itch and LFTs

Displacement of more hydrophobic endogenous bile salts from the bile acid pool; may protect hepatocyte membrane from damaging toxicity of bile salts, enhance bile acid clearance across the placenta from the fetus

Question 11

When to give vitamin k

Answer 11

Prolonged prothrombin time

5-10mg daily dosing

Question 12

Postnatal follow up

Answer 12

Counselling

Ensure LFTS normalized (6/52 PP)

Question 13

Bile salt what they do

Answer 13

Synthesized in the liver
End products of cholesterol metabolism
Usually tightly regulated
Responsible for emulsification of fats and fat-soluble vitamins

Question 14

Mechanism of action

Answer 14

Raised estrogen and progesterone
Serve as partial agonists for bile acid receptor and impair bile acid homeostasis

Women have higher serum concentrations of sulfates progesterone

Question 15

Dose of UCDA

Answer 15

500my BD

Question 16

DDx

Answer 16

AFLP
HELLP
HG
Atopic eruption of pregnancy
PEP
PG
Viral hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangtits
Autoimmune hepatitis
Drug-induced liver injury

Question 17

Increasing risk with increasing bile acids

Answer 17

1-2% increase in risk for every 1 micromole per liter increase in bile acids above 40

Question 18

Fetal-protective effect of UDCA

Answer 18

Reduced preterm labour
Reduced fetal distress
Reduced respiratory distress
Reduced NICU admission

(2 x meta analysis)

Question 19

Rifampicin for OC

Answer 19

Choleretic antibiotic
Reduces puritius and enhances bile acid excretion

Combined with urso, 50% reduction in BA