Obstetric Cholestasis

Question 1

What is OC?

Answer 1

• it is a rare liver disorder that only occurs during pregnancy
• it is a disruption and reduction of bile products from the liver and its flow to the intestine
• condition usually occurs after 28th wk of pregnancy when oestrogen levels are at their highest

Question 2

What are the signs and symptoms?

Answer 2

• intense pruritus (itching) mainly affecting hands and soles of feet, more severe at night, no visible rash
• UTI
• pale stools
• possible jaundice
• diagnosis is confirmed if raised serum bile acids are found and other causes for these results are excluded

Question 3

What are some of the complications of OC?

Answer 3

• causes severe liver impairment and may abuse liver failure in the woman
• increased perinatal morbidity and mortality
• premature delivery
• meconium-stained liquor
• fetal distress
• IUD

Question 4

How is it treated?

Answer 4

• topical treatment may be used to provide some relief from pruritus
• chlorpheniramine (sedation at night)
• ursodeoxycholic acid - displaces bile salts and protects the hepatocyte cell membrane from the toxic effects of bile salts
• vitamin K 10mg - reduce risk of PPH and fetal or neonatal bleeding

Question 5

What is the role of the midwife antenatally?

Answer 5

• bloods tests to exclude hepatitis A,B,C etc
• lft’s measured weekly once confirmed
• detailed booking history to highlight any previous OC
• transfer to consultant-led unit
• monitor fetal movements
• regular ctg’s may be performed but no evidence to guest this improves fetal outcomes
• possibility of pre term delivery - view NNU
• direct woman to support groups and give information leaflets

Question 6

How does care differ in labour?

Answer 6

• ?IOL 37-38 wks
• CTG
• active 3rd stage

Question 7

What is the role of the midwife postnatally?

Answer 7

• ensure LFT’s return to normal, defer test for at least 10 days
• high recurrence risk
• avoid contraceptives that are oestrogen based