obstetric cholestasis

Question 1

what

Answer 1

reduced outflow of bile acids from liver

Question 2

when does it usually develop

Answer 2

> 28wks

Question 3

assoc w increased risk of

Answer 3

stillbirth

Question 4

features

Answer 4

pruritus 
fatigue 
dark urine 
pale, greasy stools
jaundice 
NO rash

Question 5

if rash present

Answer 5

it’s not obstetric cholestasis

alt diagnosis

• polymorphic eruption of pregnancy
• pempphigoid gestationis

Question 6

Ix

Answer 6

liver function tests

bile acids

Question 7

Ix results

Answer 7

abnormal LFTs - ALT, AST, GGT

raised bile acid

Question 8

ALP

Answer 8

normal for it to be high in pregnancy - it is produced by placenta

raised ALP w/o any other abnormal LFTs is not liver pathology

Question 9

Mx

Answer 9

ursodeoxycholic acid

emoilients
antihistamines for sleeping

Question 10

Mx - if PTT derranged

Answer 10

water soluble vitamin K

Question 11

delivery

Answer 11

planned delivery after 37wks may be considered if LFTs and bile acids derranged