Antenatal Care - Obstetric Cholestasis

Question 1

What is Obstetric Cholestasis?

Answer 1

Intrahepatic Cholestasis of Pregnancy (usually after 28 weeks).

Question 2

Pathophysiology of Obstetric Cholestasis.

Answer 2

1. Reduced outflow of bile acids from the liver.
2. Result of increased Oestrogen and Progesterone levels.

Question 3

Physiology of Bile Acids.

Answer 3

1. Produced from breakdown of Cholesterol in Liver.
2. Flow from liver through Hepatic Ducts, past Gallbladder, through the Bile Duct into the Intestines.

Question 4

Clinical Presentation of Obstetric Cholestasis.

Answer 4

1. Pruritus (Main Symptom) - Palms of Hands and Soles of Feet.
2. Obstructive Jaundice - Fatigue, Dark Urine, Pale & Greasy Stools.
3. NO Rash.

Question 5

Investigations of Obstetric Cholestasis.

Answer 5

1. Abnormal LFTs (ALP is produced by placenta too so this could be normal).
2. Raised Bile Acids.

Question 6

Management of Obstetric Cholestasis.

Answer 6

1. Ursodeoxycholic Acid - Mainstay.
2. Symptomatic : Emollients (Soothe Skin) and Antihistamines (Help Sleeping; NOT itching).
3. Water-Soluble Vitamin K if clotting is deranged.

Question 7

Monitoring of Management of Obstetric Cholestasis.

Answer 7

1. Monitor LFTs weekly and after delivery after at least 10 days to ensure resolution after birth.

Question 8

Complication of Obstetric Cholestasis.

Answer 8

STILLBIRTH.