*Please Read* Obstetric Cholestasis

[leanne4stars]

i am on my 6th pregnancy (5th was miscarriage) x firsy 4 all full term normal vaginal deliverys no complication pregnancies

currently on wk 36 and this pregnancy which has been a nightmare from finding out at 4 wks pregnant

suffered with severe sickness, was diagnosed with hyperemesis and spent some time in hospital on a drip

sickness hasn't stopped at all but has slowed down to just a morning now

last week at 35 wks i developed all over itch but severe hands and feet itch especially at night

told my midwife who dismissed it as hormones and change in weather (uk currently entering summer)

googled itchy hands and feet that night and took myself to hospital the following morning where i underwent numerous blood tests and was quickly diagnosed with OC

never heard of it before and panicked like mad working myself up into such a state

have been back to the hospital 2 times for more tests as my levels are still rising even though i am lots of tablets now, also waiting for a liver scan

to top it off a swab showed i had bv

and 2days urine test showed 3+ sugar in my urine

decided with our ob at todays appt i will be induced at 38 wks, having tests twice weekly until then, so 13 days 2 go but am still soooo worried about all these abnormalities

and heres me thinking i should be a pro by now ........

 

[saraxx]

I've suffered from reallllly bad iching, where i get soo hot and its all over, my arms, legs, ears, hair line esp, hands, fingers, feet etc you name it, it iches! When i went to my last mw app i told her she said yea yea its all part of pregnancy, its just your hormones.... i looked into it on the internet, and this topic was brought up, after about 2 weeks i booked a doctors app, and they arranged a blood test, my results have come back fine, but this is just so irritating, even my O/H says to me please stop iching your maing me iche, not alot i can do, i found that putting a moisturiser all over my body can help, i think my skin has turned extremely dry, and this again could be the cause. x

 

[mikababy]

It's interesting how dismissive some midwives are of women who have OC symptons!

I've had what feels like constant crawling and biting insects all over my hands, feet, legs, and arms since Thursday before last. It got so bad after a couple of nights that I was convinced there were fleas in the bed (we don't have any pets!) and I was fed up and exhausted and went and tried to sleep on the sofa.

I looked up online that night and then called the hospital midwife the following morning.
I was told quite firmly "If you're not itching on the palms of your hands and soles of your feet, you don't have OC, you have an allergy. Take some piriton and call back in an hour and a half".

As soon as I told them the piriton hadn't done a thing they asked me in and I spent 2 days waiting for various blood tests and monitoring to be done, especially as I have been feeling gradually more wiped out and my appetite has vanished. They've put me on the URSO even though my results have come back normal after 2 lots of tests, as it can take a few weeks for the bile salts (bilrubin) to build up enough to detect.

Does anyone else feel like the 'itching' is more like little tickles and bites or 'spikes' from an insect? It doesn't feel like the itchiness I might get if I had, say, a mosquito bite or just a normal kind of itch. The palms of my hands actually feel like they're tingling and burning too.

 

[dt1234565]

TMI question! I have had itching on hands feet and scalp and indeed all over which is mostly worse at night. Thing is and this is the TMI bit, my stools have now turned a orange red colour could this be relevant? I had a blood test 3 weeks ago which was fine but am getting a bit concerned again? Thanks x x

 

[mikababy]

Hello,

I am in the same boat (and yes TMI, but mine are bright orange as well!). Is the itching responsive to Piriton and is it also on the palms of your hands and soles of your feet? If you are concerned, I would definitely go back to your midwife and if everything points towards O/C (in spite of the blood results - see below) then query about being put on the URSO acid and receiving extra monitoring.

My blood results (weekly tests) have also come back 'normal' this morning, but from the research I've been doing, Liver Function Tests can still come back O.K when a woman has O/C and do not normally elevate until the liver is not functioning as well as it could due to damage. An elevation in the alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels taken together can indicate O/C and are the next most reliable indicator in the absence of a Serum Bile Acid test. Although ALP levels do also rise in the later stages of pregnancy as the placenta increases production, so this isn't reliable on its own.

(I have asked for a Serum Bile Acid Test, but have pretty much been fobbed off, as this isn't a 'standard' test and it has to be sent off.)

Hope you make some progress and get some answers.

xx

 

[dt1234565]

Hello,

I am in the same boat (and yes TMI, but mine are bright orange as well!). Is the itching responsive to Piriton and is it also on the palms of your hands and soles of your feet? If you are concerned, I would definitely go back to your midwife and if everything points towards O/C (in spite of the blood results - see below) then query about being put on the URSO acid and receiving extra monitoring.

My blood results (weekly tests) have also come back 'normal' this morning, but from the research I've been doing, Liver Function Tests can still come back O.K when a woman has O/C and do not normally elevate until the liver is not functioning as well as it could due to damage. An elevation in the alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels taken together can indicate O/C and are the next most reliable indicator in the absence of a Serum Bile Acid test. Although ALP levels do also rise in the later stages of pregnancy as the placenta increases production, so this isn't reliable on its own.

(I have asked for a Serum Bile Acid Test, but have pretty much been fobbed off, as this isn't a 'standard' test and it has to be sent off.)

Hope you make some progress and get some answers.

xx

Wow thank you for that. Thats really interesting. My Alk Phos was high at 438 and sodium low at 134. Itching is in hands and feet legs under arms scalp and boobs mostly. Think i sicklk definately seek more advice as am due in 2 weeks x Thanks for your answer and i hope we both get a definative answer soon x

 

[dt1234565]

So update. Went back for more texts today and ALP has raised to 563. Albumin is 34 and ALT is 29. I have been asked to go back next week to repeat the tests as my levels have risen and have a consultants appt too. But i dont know why or what the test results mean. Does anyone know? X

 

[mikababy]

For info from the British Liver Trust. The LFT unfortunately doesn't measure the actual levels of bile acid in the blood, but as I said before, raised ALP & GGT together are the next best indicator. Hope your Consultant is more helpful in explaining all this than the midwives/obstetrician have been at my local hospital!


Liver Function Tests


The most common sections of the test are:

• Alanine aminotransferase (ALT)
• Aspartarte aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Gamma glutamyl transferase (GGT or ‘Gamma GT&#8217
• Bilirubin
• Albumin

"Each of these has results given to them in numbers and values. The laboratory provides a ‘normal value’ or ‘reference value’ to the test, which shows the doctor, nurse or specialist whether your test is within the normal range. Abnormal functions are shown by how much they are below or above the normal range.

Usually the liver function test gives an indication of how much your liver is inflamed and possibly either damaged or changed in its ability to work properly. The test does this by measuring the following:

ALT and AST levels, which indicate the degree of inflammation. The aminotransferases are enzymes that are present in the liver cells (hepatocytes). They leak into the blood stream when the liver cells are damaged. These values are usually high in hepatitis – possibly twenty to fifty times higher than normal. The ALT value is more specific to the liver than the AST value. The AST value may also give an indication of muscle damage elsewhere in the body. Ratios of these enzymes can be helpful in NASH and alcohol-related liver disease.

Alkaline phosphatase (ALP), an enzyme found mainly in the bile ducts of the liver. Increases in ALP and another liver enzyme called Gamma GT (GGT) can indicate obstructive or cholestatic liver disease, where bile is not properly transported from the liver because of obstruction (blockage) of the bile duct. GGT is tested with ALP to make sure that ALP increases are coming from your liver. The GGT is also a potential indicator of your alcohol usage.

Bilirubin, formed from haemoglobin and the main pigment in bile (a yellow/green substance made by your liver). An increase of bilirubin causes jaundice, a yellowing of the eyes and skin in liver disease.

Albumin, a very important protein that helps keep fluid pressures in the body stable and carries many substances in the body. Albumin may decrease in chronic liver disease, particularly if the disease is getting worse, but may be decreased for other reasons such as a lack (deficiency) of protein, for example malnutrition.

All of the above can be affected by disorders and diseases that do not affect your liver directly. As strange as it sounds, ‘abnormal’ liver function test results are not uncommon. However, further investigation should be considered if any of your results are found to be outside of the normal range in a liver function test".

Hope your appointment goes O.K and let us know how you get on.

xx

 

[Jchihuahua]

So update. Went back for more texts today and ALP has raised to 563. Albumin is 34 and ALT is 29. I have been asked to go back next week to repeat the tests as my levels have risen and have a consultants appt too. But i dont know why or what the test results mean. Does anyone know? X

Did you have the bile acid test done hun? that was what clinched my diagnosis?

 

[dt1234565]

I have no idea! I didnt know what was happening really. On my notes it says normal range is 1-14. When i asked what the results were she said 29 and that was the whole conversation! She then took me to anothere dept spoke to a consultant and made me a consultants appt for next week and arranged repeat bloods. Thing is i am due in 15 days so anything could happen in the mean time and i am a bit confused?

 

[dt1234565]

So update. Went back for more texts today and ALP has raised to 563. Albumin is 34 and ALT is 29. I have been asked to go back next week to repeat the tests as my levels have risen and have a consultants appt too. But i dont know why or what the test results mean. Does anyone know? X

Did you have the bile acid test done hun? that was what clinched my diagnosis?

How would these results show in my notes?

 

[mikababy]

You'd get an actual print out of your results which would list them all. This should be in your file or you can ask them to read the results to you over the phone. The 'normal' range that the lab refers to will normally be written in brackets next to each result, but this can vary slightly from lab to lab I think.

I only started examining mine because I'm interested in pharmacology (did a bit at Uni) and just like to know these things! The Obstetrician must think I'm a real pain! (then again, I'm going to be a Mum, so being a pain is my job when it comes to my daughter's health, thanks very much!)

 

[dt1234565]

Ah. I see. I have a print out but dont know what one is bile acids?

 

[mikababy]

A bile acid test looks at the concentrations of these acids:
* Cholic acid
* Deoxycholic acid
* Chonodeoxycholic acid

Does the readout say 'Liver Function Test' or 'Serum Bile Acid Test'?

 

[Jchihuahua]

Mine said 'serum bile acid test' on my notes but as soon as the hospital got my elevated bile acid results back they rang me to come in immediately.

 

[mikababy]

My hospital doesn't offer serum bile acid tests, just liver function tests, so I'm just in the dark!

 

[dt1234565]

It says bile acid range but nothing i can read to see what my range is? But maybe thats why i have the consultants appt. Presumably they wouldnt book one for no reason? Thanks for all your help ladies x x x

 

[dt1234565]

Finally i understand my results! My serum bile levels are 29 normal range is less than 14. My ALP is 563 normal range is 42-128

So i am back on Wednesday for repeat bloods, monitoring and to see a consultant. Do you think they will arrange an induction if i havent gone naturally before then and if so when do you think they would arrange it for? I will be 38 + 4 on Weddnesday?

Thank you.

 

[mikababy]

They are definitely higher than they ought to be.

I believe they normally arrange induction at 37-38 weeks, so would most likely be sooner than later I would imagine (if that's the route they are going to take).

Are you taking the URSO?

xx

 

[dt1234565]

I have not been given any meds. All they offered me was piriton. X