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
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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
As the Directors at the Sharp Rees Medical Facility, we will be talking about the liver. The liver is a very important organ in the human body as it does not just perform one function but is involved in multiple tasks. Some interesting facts about the liver; it weighs under five pounds, it has a shape like a half football and everyone is born with one. Just like most other disease or disorder, if the liver has not been taken care of properly there are many negative outcomes that can affect and destroy the liver. There are many complications when the liver is abused or damage for example cancer, hemochromatosis, gallbladder or
Cholecystitis is inflammation of the gallbladder. Inflammation usually forms when a gallstone blocks the cystic duct that transports bile. Cholecystitis is the most common problem resulting from gallbladder stones (90% of the cases).
One of these symptoms is jaundice, which is characterized by yellowish skin and eyes because of an inability of the liver to remove bilirubin from the blood. Patient with cirrhosis also suffering from itching, due to deposited bile's products in the skin. This patient also suffers from accumulation of fluid in legs that is called edema. As a result of the blockage of blood flow via the liver, fluid accumulation in abdomen which is worsen by the decrease in protein production. Other symptoms include fatigue, weakness, loss of appetite, weight loss and nausea. As the disease progress, complications may develop ,such as varices that happens with cirrhosis patient when the blood flow through the liver slows, so the blood from intestine go back to the vessels of the stomach and esophagus, these vessels are not meant to carry this much of blood so they dilate (varices), with increasing
Bile is released into the gut in order to help with the digestion of foods consumed. The bile contains chemicals that break down/emulsify fats by dispersing fat globules into smaller droplets, therefore increasing the surface area of the fats. Because of an increased surface area, more reaction will be able to take place; therefore a quicker reaction will take
It 's 2:30 in the morning, and the only thing that surrounds me are the continuous sounds of dry heaves and vomit, spewing into the toilet in front of me. This is my third pregnancy. Hyperemesis Gravidarum - the diagnosis I have now heard three times. But this time, the circumstances were a bit different. Just a few short months ago, my husband and I made the decision to have my tubal ligation reversed. We had previously talked about the possibility of having more children and knew the challenges we were likely to face. But it wasn 't until my diagnosis that it became a reality that it was no longer on my time.
Ms. Pedroso is a pleasant 36 years old, pregnant females. She became pregnant after a first in-vitro attempted. Currently, the patient is 25 weeks of gestation and has come to the clinic with a chief complaint of recurring heartburn, which she described as a flame-throwing sensation in the epigastric area, abdominal bloating, and a sour taste in the back of her mouth. Ms. Carrillo states noting her symptoms two weeks ago and verbalized the symptoms worsen after eating; particularly after a heavy meal and with certain foods. She describes her pain 8/10 on the pain scale. The patient denies any chest pain or shortness of breath. Ms. Pedroso only known health problem is primary hypertension.
Pregnancy. Changing hormonal status during pregnancy causes reduced secretion of bile salts and reduced mobility of the gallbladder, which increases the risk of gallstones.
This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks
Celiac disease (CD), one of the most common autoimmune disorders in the world, is also one of the most underdiagnosed, in no small part thanks to the many different ways it can present in the clinic. Celiac disease was thought of as a children’s malabsorptive disease and was characterized by chronic diarrhea, abdominal distension, fatigue, and vomiting. But celiac diease patients can experience many non-gastrointestinal symptoms, including the effect of the reproductive of health of women. “The problem with celiac disease and pregnancy is that you have poor absorption of nutrients, because you have all of this constant diarrhea and an inflammatory reaction in your bowels,” says Michelle Collins, CNM, an assistant professor of nurse-midwifery
The patient I completed my family health assessment on is a 34 years-old African American (black) female that is Gravida 6 Para 6. Her primary language spoken is English. She has a history of five vaginal deliveries and one cesarean section. This delivery was a vaginal birth after cesarean (VBAC) with spontaneous rupture of membranes while at home. Initial progression of labor was slow until stimulation of nipples via breast pump and low, slow dosing of Pitocin.
A 24 year old female at 27 weeks gestation presented to our institution with abdominal pain and concern for preterm labor. The patient had undergone a laparoscopic cholecystectomy for chronic cholecystitis ten days prior at another institution, which is where she presented for a prenatal visit. In the transfer record, patient had multiple recent admissions due to emesis, attributed to hyperemesis gravidum and cholecystitis. On admission to our institution, she complained of uncomfortable cramping abdominal pain with concern for preterm labor. She was febrile, with a leukocytosis of 26.3. The obstetric service performed a negative amniocentesis for what they suspected to be chorioamnionitis. Ten hours after admission, her pain failed to improve, she was placed on piperacillin/tazobactam. MRI was obtained and demonstrated a
Gastroschisis is a congenital birth defect characterized by immature development of the anterior abdominal wall in utero. This rare malformation occurs in the first trimester of pregnancy and results in the development of loops of bowel, intestine, and other organs outside of the abdominal wall, typically, to the right of the umbilicus. These structures are not covered by a protective overlying sac and are exposed to air when the infant is born, potentially causing them to become irritated, inflamed, swollen, or damaged (Centers for Disease Control and Prevention, 2014). It is estimated that gastroschisis occurs in approximately 1 per 5000 live births, with the prevalence increasing worldwide (Mac Bird, Robbins, Druschel, Cleves, Yang, & Hobbs,
known risk factor is advanced maternal age-at age 35, a woman has 1 chance in
It is widely agreed upon in medicine that time is of the essence when it comes to diagnosis and treatment of disease. The pediatric disease, biliary atresia (BA) is no different in this regard, as it has been well accepted for several decades that the timely recognition and repair of BA is essential1. BA is a progressive, idiopathic disease characterized by extensive fibrosis of the extrahepatic biliary tree resulting in blockage of bile flow. BA is the most common cause of surgically correctable jaundice. It may also clinically manifest as scleral icterus, acholic stools, and urobilinogen; eventually leading to cirrhosis and hepatic failure if the disease is left untreated. BA is often fatal before the age of one year old if left untreated and as a result has become the most common indication for liver transplant in children1,2. The hypothesized pathogenesis of BA includes viral, immunologic, and genetic etiologies but currently no definitive cause for BA is known. The gold standard in diagnosing BA is intraoperative cholangiogram, which allows for direct progression to surgical correction of the anomaly if characteristic findings of BA are seen. The most common surgery performed in patients with BA is the Kasai Portoenterostomy (KP); which is intended to restore bile flow to the liver and proximal small bowel3,4. An early indication of a successful KP is resolution of jaundice demonstrating return of bile flow; the earlier in infancy this occurs the better the
Obstructed labour carries a high risk of maternal morbidity and mortality and is prevalent in the developing world. Common causes include congenital fetal abnormalities like polycystic kidneys, hydrocephalus, hydronephrosis, locked twins, uterine abnormalities, contracted pelvis & maternal pelvic tumours (1,2). A case of Prune belly Syndrome diagnosed in the postpartum period is presented here which led to obstructed labour. She was successfully managed by trans abdominal tapping of cystic masses and subsequently delivered vaginally.