Open AccessOBSTETRIC CHOLESTASIS
Author(s) -
P Pradhan
Publication year - 2003
Publication title -
journal of nepal medical association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.176
H-Index - 19
eISSN - 1815-672X
pISSN - 0028-2715
DOI - 10.31729/jnma.766
Subject(s) - medicine , pregnancy , ursodeoxycholic acid , cholestasis , etiology , jaundice , bile acid , cholestasis of pregnancy , liver function , fetus , liver disease , obstetrics , pediatrics , genetics , biology
Obstetric Cholestasis is the commonest liver disease that causes pruritis and is uniqueto pregnancy. Pruritis can be so intense as to lead insomnia.The Significance of thisdisease has been highlighted more recently due to the associated perinatal mortalityand maternal morbidity. Aetiology and pathophysiology still uncertain. There, appearsto be genetic predisposition in certain individuals resulting in an increasedsusceptibility to the high oestrogen levels found in pregnancy specially in 3rdtrimesterand resolving promptly after delivery when oestrogen level falls rapidly. Pruritis iscentral in origin and thus fails to respond to commonly used antihistamines and lotiocalamine locally. Recently ursodeoxycholic acid an exogenous bile acid is increasinglybeing used and showed improved both pruritis and liver function and favourablechanges were observed in the foetus as well. Delivery planned at 37-38 weeks ofgestation reduced perinatal mortality. Because of increased rate of adverse intrapartumevents, close monitoring is appropriate. Active management of the third stage isnecessary because of the increased risk of post partum haemorrhage.Key Words: Pruritis, pregnancy, planned delivery, perinatal mortality and maternal morbidity.