Obstetric Cholestasis

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Obstetric Cholestasis (OC) or Intraheptic Cholestasis of pregnancy is a disorder that is unique to pregnancy (Kelly and Nelson-Piercy, 2000).OC classically presents in the third trimester (Royal College of Obstetricians and Gynaecologists [RCOG], 2006), With maternal pruritus and raised bile acids (Geenes and Williamson, 2009).It is one of the few disorders of pregnancy that can affect both maternal well being and fetal outcome. OC usually resolves forty eight hours after delivery (Mays, 2010). This essay will examine the functions of the liver and discuss the role of bile acids in OC. The pathophysiology of OC will be explored. The role of the midwife within a multidisciplinary team, alongside the physical care that is offered to women…show more content…
According to Bruce and Watson’s (2007) list of risk factors, Jacinta was increasingly at risk of OC as she had a family history and a previous OC pregnancy, as well as advanced maternal are >35years. Diagnosis of Obstetric Cholestasis is made by excluding all other liver diseases. Blood test to assess OC should generally include Liver Function tests as well as screening for Hepatitis B and C and Serum bile acids. (Bryne, 2000). Kenyon et al 2001 suggest that bile acid levels will often rise before liver function tests become abnormal so continual investigation is vital. Jacinta presented with intense pruritus however her liver function tests and serum bile levels were initially normal. Many women will have pruritus for days or weeks before the development of any abnormal liver function (Kenyon et al 2001). Midwives need to be extremely vigilant and not ignore persistent pruritus even in the presence of normal blood results. Diagnosis is suggested if a woman in the third trimester of pregnancy develops pruritus without a rash and at least one biochemical liver abnormality (See appendix) (Walker, Nelson –Piercy and Williamson, 2002). However OC has been diagnosed in women at only eight weeks gestation, (Mays 2010) and Jacinta presented to her General Practitioner with pruritus at twenty four weeks. Diagnosis can be extremely

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