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What is Obstetric cholestasis?

Obstetric cholestasis or OC is not so common in pregnancy. It is a condition of the liver which gives a feeling of itchiness in a severe intensity. It is also called ICP – intrahepatic cholestasis of pregnancy. This condition is common in Indian or Pakistani Asians.

Causes of OC

• The triggers of OC are not well known. But the underlying cause is the way the bile is used up. Bile is a juice that the liver produces in order to break down fats in the food in the gut. Bile passes through the bile duct and then into the intestines. With the condition of OC, bile juice volume lowers down into the intestines. This is the reason bile salts begin to build up in the body.
• Progestrerone and Oestrogen hormones are also considered as the reasons behind OC. The levels of the hormones are sensitive to the body and this in turn affects the working of the liver.
• Genetics, race or a family history can also be a reason for OC.

Symptoms of OC

• Primary symptom is severe to mild itching.
• Palms get itchy
• Soles of the feet get itchy
• Worse itching during night
• No rash involved
• Jaundice may develop
• Yellow tinged skin color
• Wee dark to pale poo
• Viral infections

What should be done when there are above symptoms?

Tell the midwife or doctor about your symptoms. Possible examinations like blood tests shall reveal the condition of OC if present. The doctor shall also check for working of liver by measuring bile salts levels in the body. Itching might be persistent for many weeks before showing it in the tests. Hence, the tests shall be repeated. An ultrasound scan can confirm if the case is something else like gallstones that block the gut.

Effect of OC

There is no harm in having OC, but it is quite uncomfortable to live with it. Itching shall disappear once the delivery takes place. Itchiness is worst during night which can range from mild from severe for different woman. The ability to clot the blood by the body is effected with OC. Hence, in case of any bleeding, it might not stop like usual. Vitamin K tablets are advised for the same for blood clot. Extra care has to taken with antenatal checkups and other tests with the condition of OC.

Effect on the baby

Baby might be delivered early, that is prior to 37 weeks of pregnancy. This is due to preterm labor or due to doctor’s advice for the safety of baby. In case of OC, baby passes its first poo called meconium prior to the birth leading to breathing issues in the baby. Hence delivery is monitored carefully.

Tests may include

• Baby’s heartbeat
• Track of baby’s movements
• Ultrasound scans

Treatment of OC

• Giving birth is considered to be the only cure for OC, that is, the problem goes away with giving birth.
• Antihistamine creams and tablets may be prescribed to aid with itching issues.
• A drug named Ursodeoxycholic acid might be advised in the condition of OC which aids in proper working of liver and thus relieve you of itching problem.
• Vitamin K is prescribed to be taken on a daily basis to improve the ability to clot blood which is hindered due to OC. This will reduce heavy bleeding after delivery in mother.

After birth

• Follow up appointments are recommended 6-8 weeks after delivery.
• Monitoring of working liver in a normal way and relief from itching is done.
• Birth control pills are asked to be avoided.

OC in the first delivery may extend to other deliveries too in the same woman. But there are cases where the condition might not repeat. It is different in every woman.

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