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Obstetric Cholestasis

From The British Liver Trust (http://www.britishlivertrust.org.uk)

Obstetric Cholestasis (OC) or Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder that occurs in around one in 140 pregnancies (0.7 per cent) in the UK, where the normal flow of bile out of the liver is reduced. Chemicals in the bile called bile salts (also often referred to as bile acids) can then build up and 'leak' into the bloodstream. This causes affected women to have increased levels of bile salts in their blood.

The condition is also characterised by itching, known as pruritus, which generally appears in the last three months of pregnancy (though can appear sooner). It is of variable severity and can be extremely distressing for the mother. Both the raised bile salts and pruritus completely disappear soon after the birth and generally do not appear to cause long-term health problems for mothers.

There can be an increased risk of preterm delivery (both spontaneous and induced) and fetal distress. Some case studies have also reported stillbirth occurring near the end of pregnancy in women with he conditon and therefore it is essential that the condition is recognised and treated in time.

At present, most maternity units in the UK managing women with OC/ICP pregnancies deliver babies early, at around 37 or 38 weeks. This is done because it is thought that it may help prevent the possibility of stillbirth. There have been no reports of any harmful effects to babies from OC/ICP pregnancies once they have been delivered. The clinical importance of OC/ICP is the potential risks to the fetus, including spontaneous preterm birth, iatrogenic preterm birth and fetal death.

OC/ICP is more common in multiple pregnancies, and is more common in women of Indian or Pakistanie origin, affecting around one in 70 to 80 (1.2 - 1.5 per cent) pregnancies. In other countries such as South America and Scandinavia, the number of women affected is higher still. Women with hepatitis C are at increased risk.

Itching is often the only symptom. It usually begins on the arms, legs, hands and soles of the feet, but can occur on other parts of the body. It is usually worse at night, leading to sleeplessness and exhaustion. Itching can be intense, and women can scratch themselves until they make themselves bleed. Some women will develop jaundice but most do not.

Diagnosis is made on the basis of symptoms and history and liver function tests, which will reveal raised levels of the liver enzymes alamine aminotransferase (ALT) and aspartate aminotransferase (AST. Sometimes gamma-glutamyl transferase (GGT) will also be raised. The most specific test involves measuring serum bile acids: levels greater than 14μmol/L (10μmol/L in a fasting blood sample) are considered raised.

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