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Obstetric cholestasis

Obstetric cholestasis.

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Obstetric cholestasis

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  1. Obstetric cholestasis

  2. Obstetric cholestasis (OC) is also known as intrahepatic cholestasis of pregnancy and is a condition specific to pregnancy that denotes a disruption and reduction of bile products by the liver. It is diagnosed by the presence of raised serum bile acids and usually appears aher the 28th week gestation, resolving a couple of weeks following the birth of the baby.

  3. Obstetric cholestasis manifests as intense itching (pruritus) that mainly affects the soles of the feet, hands and body, becoming worse at night, albeit there is no visible rash. The woman ohen complains of loss of sleep. Urinary tract infections (UTI) are common and jaundice may occur, with the woman stating that her faecal stools are pale.

  4. Treatment is based on the use of topical creams, but medications such asTreatment is based on the use of topical creams, but medications such as • ursodeoxycholic acid and chlorampheniramine may be prescribed. Obstetric cholestasis causes severe liver impairment and increases perinatal morbidity and mortality (Saleh and Abdo 2007). Timing of the birth depends on gestational age and fetal wellbeing, which is monitored through fetal growth and biophysical profiles, fetal movements and CTG.

  5. Birth before 38 weeks is usually advocated (RCOG 2011a). There is also an increased risk of postpartum haemorrhage (PPH) due to coagulation disruption. Oral vitamin K 10 mg is ohen prescribed to lessen the risk and active management of the third stage of labour is advised. Postnatal care is based on ensuring liver function tests (LFTs) return to normal. Recurrence in a subsequent pregnancy is high, at around 90%.

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