Obstetric cholestasis

 Obstetric cholestasis

Obstetric cholestasis is estimated to affect about 1% of pregnancies in Caucasians, although the prevalence is higher in Chinese and South Asian populations. The cause is incompletely understood but the condition is thought to be due in part to the cholestatic effect of high oestrogen levels. The typical presentation is in the third trimester with pruritus, particularly affecting the soles and palms. Laboratory with pruritus, particularly affecting the soles and third trimester with pruritus, particularly affecting the soles and palms. Laboratory testing reveals raised levels of bile acids and abnormal LFTs. The diagnosis can be made on the basis of these clinical features when other causes of liver dysfunction and pruritus have been excluded. Treatment is with ursodeoxycholic acid in a starting dose of 250 mg twice daily, which usually improves symptoms and liver function. Aqueous cream with menthol can also be effective in soothing pruritus. There is an increased risk of fetal mortality with evidence of a particularly high risk when bile acid levels are over 40 μmol/L (97.9 μg/mL). Treatment therefore aims to bring bile acids below 40 μmol/L and some centres induce labour before 40 weeks in an effort to reduce the risk. The risk of recurrence in future pregnancies is high.