Cholestasis+of+Pregnancy

This page has been edited {$pagerevisions} times. The last modification was made by user:{$revisioneditor} on {$revisiondate}

** CCRMC OBGYN **** Prenatal Guideline ** Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

= **Cholestasis of Pregnancy** =

> **__ Treatment: __** > >.
 * **__ Diagnosis: __**
 * 1) Generalized pruritis **without** rash or other lesion as explanation occurring in second or third trimester. May have excoriations from scratching.
 * 2) Order bile acids and LFTs. Bile acids are ideally done fasting but for logistical reasons and to avoid delay they are usually drawn and run regardless of fasting state.
 * 3) Elevated transaminases and pruritis are usually enough for presumptive diagnosis, monitoring and treatment pending bile acid result. Note alk phos is normally elevated and albumin is normally low in pregnancy
 * 4) Any elevation in bile acid is considered positive. To confirm than can be re-checked fasting, if she is not yet on treatment (Urosodiol)
 * 1) Urosodiol (Actigall) 300mg bid to tid. This will relieve itching and lower bile acids. It has not been shown to decrease incidence of fetal demise.
 * 2) Start Antepartum testing pending bile acids if gestational age > 28 weeks.
 * 3) Induction of Labor at 37 weeks or diagnosis if later. Usually induce only if documented elevated bile acid but may consider with symptoms/transaminases if compelling history i.e. prior induction for cholestasis.
 * 4) Antepartum testing appts can be used to follow up on lab results concurrent with monitoring
 * 5) More significantly elevated bile acids >40 indicate higher risk for demise
 * 6) Consultation with OB Dept physician recommended especially for higher bile acids, earlier diagnoses, or uncertain cases.