Obstetric Cholestasis

Obstetric Cholestasis

Obstetric cholestasis is a condition that affects one in every 140 women in the UK, around 5500 a year. While itching is often common in pregnancy due to raised hormone levels, the itching can sometimes be caused by the liver condition obstetric cholestasis.

Medical experts advise that pregnant women should wear loose clothes so that your skin is able to breathe and is less likely to be irritated. This in turn, would then make it easier to distinguish between general itching and the potentially serious liver disorder.

Normally, bile acids transfer from your liver to your gut which helps the body digest its food. With Obstetric cholestasis, bile acids do not transfer properly and build up in a pregnant woman’s body. The itching that this causes, (a condition known as pruritus), generally appears in the last three months of pregnancy, but it can appear sooner. Studies have shown that women who suffer from the condition are more likely to give birth to premature or still born babies particularly if the bile acid level in the blood is greater than 40 umol/L. The risk of still born babies increases from 1 and 2 out of 100 to 4 and 5 out of 100 when the bile acid levels reach 80 umol/L. If women have the condition, it is advised that they give birth in hospital with a consultant-led maternity team.

Generally, the main symptom of itching is predominantly on the hands and feet. For many suffers the itching becomes unbearable particularly at night when the sufferer is warmer.

If diagnosed, it is imperative that the sufferer has regular liver function tests to monitor the condition. The Royal College of Obstetricians and Gynaecologists advise weekly tests and bile acid measurements so that doctors can be aided sufficiently, in judging when the baby should be delivered. However, the frequency of testing may often depend on how badly the patient is suffering.

Suffers will often be prescribed creams such as aqueous cream with menthol to relieve the itching and sometimes ursodeoxycholic acid has the same affect and reduces bile acids. If diagnosed, your doctor and midwife should always discuss your treatment options with you.

At Wolferstans, we sadly have pursued an action on behalf of a mother, who at 26 weeks began experiencing itching, predominantly on her hands and feet. She was prescribed cream to reduce the itching and was sent for a liver function test, which came back normal.

The itching persisted and at times became intolerable, particularly at night. Despite the patient raising concerns about the possibility of obstetric cholestasis , the doctors continued to rule it out because the liver function test were normal. No repeat liver function tests were carried out. At one stage the mother was taking 5-6 baths a day, in an effort to keep herself cool.

At 41 weeks the mother expressed concerns that she had not felt the baby move but was told that all was well despite the lack of foetal movements. At 41+2 weeks the mother began experiencing contractions, but was told by the midwife that she could not locate the baby’s heartbeat.

Tragically the mother delivered her baby still born.

The impact on families following the loss of a baby is devastating and Wolferstans are supporting Baby Loss Awareness Week. If you or any members of your family have been affected by baby loss or any injury at birth, and you would like to receive free independent legal advice, without any obligation, please contact Ann Ball on 01752 292374 or email aball@wolferstans.com.

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