Obstetric Cholestasis

Question 1

What is the presentation for Obstetric Cholestasis?

Answer 1

Pruritis (esp Palms + Soles)
No rash
Worse at night

Question 2

What does a rash indicate in Obstetric Cholestasis?

Answer 2

Polymorphic Eruption of Pregnancy
or
Pemphigoid Gestationis

Question 3

What is Polymoprhic Eruption of Pregnancy?

Answer 3

Pruritic condition associated with the last trimester

Lesions often first appear in abdominal striae; the periumbilical area is often spared

Management depends on severity: emollients, mild potency topical steroids and oral steroids may be used

Question 4

What investigations are performed for Obstetric Cholestasis?

Answer 4

LFTs + Bile acids
Hepatitis screen + Autoimmune screen (Smooth muscle antibodies + Anti-mitochondrial antibodies)
US of Abdomen (liver + gallstones)

Question 5

What are the maternal and fetal risks associated with Obstetric Cholestasis?

Answer 5

Maternal = Vitamin K deficiency. Increased risk of post-partum haemorrhage (PPH).

Fetal = Preterm labour. Fetal distress. Meconium. Stillbirth.

Question 6

What is the management of Obstetric Cholestasis?

Answer 6

Offer IOL at 37 weeks (when fetal maturity reached)

Vitamin K 10mg PO/24h to mother (IF ABNORMAL CLOTTING SCREEN) [from 36 weeks]
- Vitamin K 1mg IM to baby at birth.

Ursodeoxycholic acid – reduces pruritis + abnormal LFTs (also Antihistamines + Calamine)

Follow-up LFTs – done 10 days postnatal