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Flashcards in Obstetric cholestasis Deck (8)
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What is obstetric cholestasis?

- 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


Describe typical features of itching (pruritus) in obstetric cholestasis

- widespread
- often worse at night
- particularly common to affect palms of hands and soles of feet
- no rash
- often trauma from intense scratching


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

- pale stools
- dark urine
- jaundice


What are risk factors for obstetric cholestasis?

- personal or family history of obstetric cholestasis
- multiple pregnancy
- hepatitis B
- gallstones


What is the pathophysiology of obstetric cholestasis?

- 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


What are the associated risks of obstetric cholestasis?

- 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 is obstetric cholestasis diagnosed?

- 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


What treatments are available for obstetric cholestasis?

- 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)