OC and Acute Fatty Liver of Pregnancy Flashcards
What happens to the liver in pregnancy?
- Displaced by the uterus
- Fat and glycogen stores are
unchanged - There is a change in the
production of plasma
proteins, enzymes, lipids
and bilirubin - These changes are a
response to increased
blood volume and increase
in oestrogen - LFT’s (liver function tests)
can mimic liver disease - There is an increase in
albumin levels - There is a decrease
cholesterol, fibrinogen and
liver proteins
What happens to the gallbladder in pregnancy?
- Increase in progesterone causes hypotonic gallbladder - Bile storage is increased - Rate of emptying slows - Bile becomes diluted - Cholesterol conversion is decreased - Cholesterol based gall stones more likely, especially in the 2nd and 3rd trimester - Bile salts are retained
Incidence of OC
The most common disorder of the liver in pregnancy. The incidence is 1:200 to 1:2000 and is poorly recognised by HCP
When does OC usually present?
30/40
What is OC known to be due to?
An accumulation of bile salts but isn’t really a cause
Risk factors for OC
- OC in previous pregnancy
- Genetic; OC in a first degree relative and also certain ethnic groups
- Twin pregnancy
- Environmental factors
- Symptoms can reoccur with the use of contraceptives containing oestrogen
Presenting signs and symptoms of OC
- Pruritus (itching) of the trunk and limbs (often worse at night) and without a rash - Epigastric pain - Mild jaundice - Pale stools - Dark urine and/or UTI - Nausea and/or vomiting - Irritability - Exhaustion from disturbed sleep
Potential maternal complications associated with OC
- Incidence of gallstones increased - Increased risk of PPH due to deranged clotting - Emotional and psychological wellbeing affected
Potential fetal complications associated with OC
- Increased risk of preterm labour - Increased risk of fetal distress - Increased risk of stillbirth - Increased risk of haemorrhagic disease
What is the treatment of OC?
No treatment except to deliver
OC bloods to be taken
LFTs Clotting screen Bile acids Viral serology Auto-immune screen
Medical management of OC
- Topical use of aqueous cream with menthol to soothe pruritus - Oral cholpheniramine (piriton), 4mg, up to 4 times daily, to cause sedation but not to alleviate pruritus - Oral Ursodeoxycholic acid, 10mg/kg, once a day, displaces bile salts - Oral vitamin K, 10mg, once a day, to prevent vitamin K deficiency and reduce the risk of PPH - Elective early delivery should be offered between 37-38 weeks to reduce the risk of stillbirth
Ways to relieve symptoms
Advise to take cool baths, wear loose clothing and avoid stressful situations
Postnatal care for OC
Ensure women understands there are implications for future pregnancies, as well as for family members. Obstetrician should ensure LFTs have returned to normal at GP
Advise to avoid oestrogen based contraceptives.
Acute fatty liver of pregnancy (AFLP) incidence
Very rare affecting around 1:10,000 pregnancies
