Obstetric cholestasis Flashcards

1
Q

What is obstetric cholestasis?

A
  • unexplained itching (pruritus) in pregnancy and abnormal liver function tests (LFTs) and/or bile acid accumulation that resolves postpartum
  • most common liver related disorder in pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe typical features of itching (pruritus) in obstetric cholestasis

A
  • widespread
  • often worse at night
  • particularly common to affect palms of hands and soles of feet
  • no rash
  • often trauma from intense scratching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Apart from pruritus, what are some other symptoms/signs of obstetric cholestasis?

A
  • pale stools
  • dark urine
  • jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are risk factors for obstetric cholestasis?

A
  • personal or family history of obstetric cholestasis
  • multiple pregnancy
  • hepatitis B
  • gallstones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of obstetric cholestasis?

A
  • disturbance of enterohepatic circulation results in accumulation of bile salts in blood as well as reduction of bile products from liver and subsequent flow to small intestine
  • possible reaction to increased estrogen
  • increased histamine release causes intense itching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the associated risks of obstetric cholestasis?

A
  • often offered induction after 37/40
  • increased rate of birth by c/s
  • iatrogenic preterm birth
  • excess bile acids can cause FDIU/stillbirth (fetal mortality 11-20% if untreated)
  • small increased risk of preterm labour
  • fetal distress
  • meconium liquor and aspiration
  • intracranial haemorrhage due to low vit K
  • PPH (low absorption of vit K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is obstetric cholestasis diagnosed?

A
  • care should be managed by multi-disciplinary team in tertiary setting
  • pruritus
  • abnormal liver function tests (LFTs) using pregnancy specific reference ranges
  • excluding other causes of itching and liver dysfunction
  • confirmation of postnatal resolution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What treatments are available for obstetric cholestasis?

A
  • topical emollients
  • advice about comfort measures (wearing loose cotton clothing, moisturising, cool baths/showers)
  • low fat diet
  • increased water intake
  • vitamin k supplementation
  • antihistamines at night
  • UDCA (ursodeoxycholic acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly