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Obstetric Cholestasis

What is Obstetric Cholestasis?Show [+]Hide [-]

This is a condition unique to pregnancy. It is a disorder of the liver causing excessive itching mainly of the hands and feet. It usually, but not always, develops in the last third of pregnancy and can cause difficulty in sleeping, depression and tiredness.

The liver is the largest organ in your body performing many important functions such as processing food from your digestive system, producing bile to break down fat, storing vitamins and iron, detoxifying drugs and alcohol and combating infection.

In obstetric cholestasis there is a reduction of flow of bile from your liver, though why this occurs is unclear. This reduction in bile flow leads to excessive bile salts accumulating in your circulation causing itching.

Cholestasis affects approximately one pregnancy out of every 160 in the UK. There is also a higher occurrence in the winter months and in multiple pregnancies.

How is it diagnosed?Show [+]Hide [-]

This condition is detected by a single blood test, which shows that bile acids are increased. This test would be offered to women with symptoms but is not routinely done.

Will it harm my baby?Show [+]Hide [-]

Obstetric cholestasis has been associated with an increased risk to the baby. For this reason we ask that you come to the Maternity Assessment Unit at regular intervals to keep a close eye on your baby until birth. This initially involves twice-weekly visits to the Maternity Assessment Unit. Here your baby’s well being will be assessed using a heart rate monitor. Your baby will also be scanned every four weeks to check growth as there has been an association with obstetric cholestasis and small babies.

Your blood will be checked weekly to monitor your bile acid level and liver function. To minimise any risk to your baby, labour will be induced at 38 weeks. At this gestation your baby will be mature and better able to cope with an induced labour at this time.

What treatment is used?Show [+]Hide [-]

Management of your pregnancy will include the administration of a drug called Ursodeoxycholic Acid twice a day as a tablet. There have been no adverse affects reported from using this drug in pregnancy. You will have a discussion with your obstetric consultant or a member of their team before beginning treatment. In most cases this drug has been shown to relieve the itching and improve the outcome for the baby.

Vitamin K is needed to help blood clot. In obstetric cholestasis, absorption of vitamin K may be reduced. In order to prevent this you will be given a Vitamin K tablet daily from 36 weeks.

This condition resolves quickly following the birth of your baby with no long-term effects on your health.

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