Obstetric cholestasis

Raine‐Fenning, N.; Kilby, Mark

doi:10.1017/s0965539597000016

Cited by 14 publications

(17 citation statements)

References 62 publications

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“…An increase in serum bile acids maybe the only biochemical marker of obstetric cholestasis. The sensitivity of bile acids as a predictive marker of outcome is also debated [9].…”

Section: Discussionmentioning

confidence: 99%

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Cholestasis of Pregnancy : A Prospective Study

Singh

Sidhu²

2008

Medical Journal Armed Forces India

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Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs during the last trimester of gestation. The most accurate marker for diagnosis and follow-up of ICP is increased total bile acid levels (above 11.0 micro mol/L) [1]. ICP is a benign disease with no consequences to the mother but it is associated with an increased rate of fetal morbidity and mortality. Method: A prospective study was carried out in 1500 deliveries which included 27 cases of ICP. The mode of delivery, complications and fetal outcome of intrahepatic cholestasis group were compared with rest of the deliveries. Cases having pruritic lesions of skin, viral hepatitis, gall stones, autoimmune liver diseases were excluded. Random selection of 300 pregnancies in the control group was done and their liver function tests were carried out for comparison. All the patients with cholestasis of pregnancy were treated with ursodeoxycholic acid. Result: The levels of the aminotransferases and alkaline phosphatase levels rose significantly (p < 0.05) in the study group. Cholestatic group did not have any significant difference in mode of delivery or fetal outcome from the control group. The patients in the study group were treated with ursodeoxycholic acid with significant relief in symptoms (p < 0.01), while improvement in serum bilirubin levels, alkaline phosphatase levels and aminotransferases levels were not statistically significant. Conclusion: In absence of serum bile acids levels, alkaline phosphatase and aminotransferases levels may help in diagnosis and management of cholestasis of pregnancy. Ursodeoxycholic acid treatment is effective in reducing the pruritus. MJAFI 2008; 64 : 343-345

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“…An increase in serum bile acids maybe the only biochemical marker of obstetric cholestasis. The sensitivity of bile acids as a predictive marker of outcome is also debated [9].…”

Section: Discussionmentioning

confidence: 99%

“…Fetal outcome may be improved with increased antenatal surveillance, although obstetric cholestasis has not been shown to produce changes either on doppler or on cardiotocograph and has no increased rates of small for gestational age infants [9].…”

Section: Discussionmentioning

confidence: 99%

Cholestasis of Pregnancy : A Prospective Study

Singh

Sidhu²

2008

Medical Journal Armed Forces India

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“…43 Systemic symptoms such as malaise and anorexia, if present, are usually mild. There are no other physical signs.…”

Section: Clinical Features and Presentationmentioning

confidence: 99%

“…Spontaneous pre-term delivery, in 12^44% of a¡ected pregnancies. 43,45 . Increased rates of intracranial haemorrhage.…”

Section: Effects On Fetus and Mothermentioning

confidence: 99%

Role of bile acid measurement in pregnancy

2002

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The diagnosis of obstetric cholestasis (OC) has serious implications for maternal, and especially fetal, health. Total serum bile acid concentration is an important investigation in any woman with itching in the absence of a rash during pregnancy. Results should be available within 1-2 working days. Pruritus plus raised total bile acids in the third trimester suggests a diagnosis of OC. Other biochemical abnormalities, usually a raised alanine aminotransferase, accompany or follow the finding of raised bile acids. Bile acids are sensitive, but not specific, markers for OC. The diagnosis is one of exclusion. The clinician should remain alert to other causes of liver dysfunction, either specific to pregnancy or not. Effective treatment is available that improves maternal biochemical indices and well-being. It is not clear whether such treatment reduces the risks to the fetus. More active management of OC pregnancies has reduced the associated fetal and perinatal mortality.

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“…The prevalence of the condition varies worldwide as does its presentation. A low incidence has been reported from European countries; from 0.2% in France to 2% in Scandinavia 4,5 . In Chile the prevalence in 1975 was reported to be as high as 14% of deliveries, although more recently this has been lower (4% in 1995) 6 .…”

Section: Introductionmentioning

confidence: 97%

Obstetric cholestasis, outcome with active management: a series of 70 cases

Kenyon¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. Setting Antenatal population of three London hospitals between August 1999 and April 2001.Population Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. Methods All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. Results Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21 -40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. Conclusions Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.

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Obstetric cholestasis

Abstract: Figure 1 Alterations in bile acid concentrations with gestation in women with cholestasis. (Reproduced by permission of the British Journal of Obstetrics and Gynaecology).

Cited by 14 publications

References 62 publications

Cholestasis of Pregnancy : A Prospective Study

Cholestasis of Pregnancy : A Prospective Study

Role of bile acid measurement in pregnancy

Obstetric cholestasis, outcome with active management: a series of 70 cases

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