*Please Read* Obstetric Cholestasis

[Samemka]

im currently 25wks with my 2nd baby and i had oc with my 1st and today was diagnosed again with it, as having severe itching. i was induced at 37+4 with my 1st, that was 2008. but now they are saying the rules have changed now and that they dont induce anymore with this condition as no need to. iam now very worried and dont know what to do. with my first they were adament not to let me past 38wks. now they aint fussed. what do i do?

What a load of rubbish - I'd be asking them what rules they are referring to since this is completely wrong. If you have OC and it's confirmed by the bile acid blood test (and most often raised LFTs) then you should not be going past 37 weeks. In my case I'm being induced at 39 weeks because my bile acid levels have remained within normal range (0-14 at my hospital) but because I had it during my last pregnancy and I'm itching again they don't want to take any chances.

Go back to them and tell them you're not happy and if they refuse to do anything you'll have no choice but to report them - that'll get them moving. EVERYTHING you read whether medical journals, research etc says with OC it is very important to induce as close as possible to 37 weeks!!

Let us know what happens.

 

[K12B]

Thanks saml1

Did the doctors seem particularly concerned about your LFTS? They made me stay in hospital because mine were increasing, although they are now (slowly) going down a little, and are happy for me to have weekly scans and twice weekly bloods and ctgs.

Did you take ursoflax for your oc too? xx

 

[mrs_km]

im currently 25wks with my 2nd baby and i had oc with my 1st and today was diagnosed again with it, as having severe itching. i was induced at 37+4 with my 1st, that was 2008. but now they are saying the rules have changed now and that they dont induce anymore with this condition as no need to. iam now very worried and dont know what to do. with my first they were adament not to let me past 38wks. now they aint fussed. what do i do?

What a load of rubbish - I'd be asking them what rules they are referring to since this is completely wrong. If you have OC and it's confirmed by the bile acid blood test (and most often raised LFTs) then you should not be going past 37 weeks. In my case I'm being induced at 39 weeks because my bile acid levels have remained within normal range (0-14 at my hospital) but because I had it during my last pregnancy and I'm itching again they don't want to take any chances.

Go back to them and tell them you're not happy and if they refuse to do anything you'll have no choice but to report them - that'll get them moving. EVERYTHING you read whether medical journals, research etc says with OC it is very important to induce as close as possible to 37 weeks!!

Let us know what happens.

I had OC with my last pregnancy and was induced at 39 weeks. I have been itching like made and have been tested. The highest my ALT came back at was 37.. And bile was 9. The consultant said its just a case of waiting for it to show up. But say by 37 weeks it still isnt and I'm itching like mad, do you reckon I'd be induced like yourself? x x

 

[Samemka]

Thanks saml1

Did the doctors seem particularly concerned about your LFTS? They made me stay in hospital because mine were increasing, although they are now (slowly) going down a little, and are happy for me to have weekly scans and twice weekly bloods and ctgs.

Did you take ursoflax for your oc too? xx

With Emma my LFTs and bile acids were alot higher, not sure what my LFTs were but my bile acids were 37 and this time they've only got up to 14, but neither time did I have to stay in hospital. I did have to have twice weekly monitoring (CTG and blood tests) and I had about 4 scans with Emma to check growth, so very similar to you, but this time I've had nothing scan wise - will be because I haven't gone above the 'normal' range for bile acids despite being itchy as hell. The stupid thing is because of the urso-acid I took last time, my bile acids at 37 weeks would have probably been what they were this time around at 37 weeks (just this time, they were naturally like that rather than being controlled by meds) - yet this time I'm being induced at 39 weeks.

I took ursodeoxycholic acid last time which brought my bile acids right down. This time I haven't been prescribed it because my levels have remained below 14 which my hospital say is normal (although everything I've read online says that anything above 10 indicates OC).

 

[Samemka]

im currently 25wks with my 2nd baby and i had oc with my 1st and today was diagnosed again with it, as having severe itching. i was induced at 37+4 with my 1st, that was 2008. but now they are saying the rules have changed now and that they dont induce anymore with this condition as no need to. iam now very worried and dont know what to do. with my first they were adament not to let me past 38wks. now they aint fussed. what do i do?

What a load of rubbish - I'd be asking them what rules they are referring to since this is completely wrong. If you have OC and it's confirmed by the bile acid blood test (and most often raised LFTs) then you should not be going past 37 weeks. In my case I'm being induced at 39 weeks because my bile acid levels have remained within normal range (0-14 at my hospital) but because I had it during my last pregnancy and I'm itching again they don't want to take any chances.

Go back to them and tell them you're not happy and if they refuse to do anything you'll have no choice but to report them - that'll get them moving. EVERYTHING you read whether medical journals, research etc says with OC it is very important to induce as close as possible to 37 weeks!!

Let us know what happens.

I had OC with my last pregnancy and was induced at 39 weeks. I have been itching like made and have been tested. The highest my ALT came back at was 37.. And bile was 9. The consultant said its just a case of waiting for it to show up. But say by 37 weeks it still isnt and I'm itching like mad, do you reckon I'd be induced like yourself? x x

I'm not sure if they would do it at 37 weeks - the consultant who I saw yday counted on his calendar to work out when I'd be 39 weeks, so they may do something like this for you. This was without knowing my bile acid results so it was basically going on the fact I'd had it previously and was having the same symptoms - my notes say 'very itchy, likely cholestasis - IOL (induction of labour) and the date.

I think it will depend on what level your hospital has for bile acids being abnormal. If you go above this level you should be induced at 37 weeks because I'm guessing if it's above the level (for my hiospital, 14) they 'confirm' OC and guidelines say that cases of OC should be induced ASAP from 37 weeks. Say their level is 14 too and you're bile acids are 9, and you're itchy, I'd think they'd induce you between 38-39 weeks to air on the side of caution like they are doing with me. Are you due to see a consultant for a plan of care this time???

 

[mrs_km]

im currently 25wks with my 2nd baby and i had oc with my 1st and today was diagnosed again with it, as having severe itching. i was induced at 37+4 with my 1st, that was 2008. but now they are saying the rules have changed now and that they dont induce anymore with this condition as no need to. iam now very worried and dont know what to do. with my first they were adament not to let me past 38wks. now they aint fussed. what do i do?

What a load of rubbish - I'd be asking them what rules they are referring to since this is completely wrong. If you have OC and it's confirmed by the bile acid blood test (and most often raised LFTs) then you should not be going past 37 weeks. In my case I'm being induced at 39 weeks because my bile acid levels have remained within normal range (0-14 at my hospital) but because I had it during my last pregnancy and I'm itching again they don't want to take any chances.

Go back to them and tell them you're not happy and if they refuse to do anything you'll have no choice but to report them - that'll get them moving. EVERYTHING you read whether medical journals, research etc says with OC it is very important to induce as close as possible to 37 weeks!!

Let us know what happens.

I had OC with my last pregnancy and was induced at 39 weeks. I have been itching like made and have been tested. The highest my ALT came back at was 37.. And bile was 9. The consultant said its just a case of waiting for it to show up. But say by 37 weeks it still isnt and I'm itching like mad, do you reckon I'd be induced like yourself? x x

I'm not sure if they would do it at 37 weeks - the consultant who I saw yday counted on his calendar to work out when I'd be 39 weeks, so they may do something like this for you. This was without knowing my bile acid results so it was basically going on the fact I'd had it previously and was having the same symptoms - my notes say 'very itchy, likely cholestasis - IOL (induction of labour) and the date.

I think it will depend on what level your hospital has for bile acids being abnormal. If you go above this level you should be induced at 37 weeks because I'm guessing if it's above the level (for my hiospital, 14) they 'confirm' OC and guidelines say that cases of OC should be induced ASAP from 37 weeks. Say their level is 14 too and you're bile acids are 9, and you're itchy, I'd think they'd induce you between 38-39 weeks to air on the side of caution like they are doing with me. Are you due to see a consultant for a plan of care this time???

I think so. Yesterday was the first time I saw her. Apprantly, I should've had a consultant asigned to me at 22 weeks as I had previous OC . They booked me another consultant app for 3 weeks time and have to go in every week for regular bloods and monitoring and see what happens. Its soooo annoying esp when I've had it previously. x x x

 

[abstersmum]

i had steroid injections god they sting that was last week when my lft was over 1000 but now down to 300

 

[kittykittykat]

thankyou for everyones comments. ive got midwife tuesday so gona have gd chat with her. im not sure of how high my levels are,i will ask her. i know with my son my 1st pregnancy they were always in the 30s or above never between 0-14, thats why was induced at 37wks. im gona speak with midwife and see what she believes should happen as she does not know yet that i have it again.

 

[aafscsweetie]

hi all,

just an update. went to the doctor, he was familiar with OC, so that was a good start. he sent me for blood work to do the liver functioning test and bile acids test. although, he said something that seemed a little different than what all you girls have said. he said if the liver functioning test came back abnormal than it was far more serious than if the bile acids came back abnormal. does that sound about right? from what i gathered from everyone's posts, I thought if EITHER came back abnormal it wasn't good.

 

[Samemka]

hi all,

just an update. went to the doctor, he was familiar with OC, so that was a good start. he sent me for blood work to do the liver functioning test and bile acids test. although, he said something that seemed a little different than what all you girls have said. he said if the liver functioning test came back abnormal than it was far more serious than if the bile acids came back abnormal. does that sound about right? from what i gathered from everyone's posts, I thought if EITHER came back abnormal it wasn't good.

I'm not sure either way for sure but I think what he could mean is that LFTs could be potentially more dangerous because they could be a sign of something 'else' whereas because the bile acid test is a specific test for OC (from what I've read it's the bile acid test that 'confirms' it) then they'd 'know' what was causing the raised bile acids - OC.

I'm kind of relieved to hear this tbh because the MW who took my bloods on Wednesday saw me waiting for my appt yesterday and told me my LFTs were raised since last time but the bile acids weren't back. I've been worrying since that I'll go in Wednesday to be induced and they'll say 'oh you've gone down to 9 now, thats fine' (because 0-14 is classed as normal at my hospital) - I'm 99.9% sure they won't because my LFTs are raised, I've had it before, I'm itchy as hell, and the consultant booked my induction in for these reasons before getting the bile acid result back (so if it was dependant on that I'm sure he'd have said)....and if they dared do that to me they'd have the biggest pregnant woman hissy fit ever, LOL!!

 

[aafscsweetie]

lol!! well I think even if your levels went up they wouldn't risk keeping your LO in there, right? that seems to be the 'common sense' thing to do, but as i've learned in life... not everyone has the same standards for common sense... haha!

but thanks for the info. so bile salts are the test specifically for OC? and the LFT is to rule out any other liver issues? that being said, if my bile salts come back abnormal, they will induce early, correct? just trying to be mentally prepared for maybe meeting my LO earlier than planned.

 

[poppykat]

I can not believe how different every hospital treats OC.

To not induce at 37 weeks seems crazy to me, I am just pleased that my hospital took my OC seriously. Def have a chat with your midwife and hopefully she will be able to help get you induced (if thats what you want.)

I am dreading being pregnant again as I am so scared of getting OC again. I got diagnosed with it at 32 weeks although the itching had been going on for a few weeks previous to that but I thought it was normal! I had it quite severely and they couldn't control it and Chloe was delivered very suddenly at 34+6. Not sure I could cope with another hospital stay and a baby in SCBU

Good luck to you lovely ladies and I hope your OC is not too bad xx

 

[louise1302]

i really am worrying about having to wait until 38 weeks to be induced now, i think ill strap my doppler on for the week between 37-38 weeks

if i insist on 37 weeks do you think i can 'make' them do it, my bile acids are increasing stupidly i find out monday what the most recent ones are but the last time theyd doubled

 

[aafscsweetie]

also, did they make you guys fast before doing the bile salts test?? my doctor didn't make me, but when i got to the lab the nurse said usually people are supposed to fast for 8 hours before having it done? my dr said that was silly and i could just have the test done anyway, so i did. but just wondering.

 

[abstersmum]

I didn't fast for blood tests I did have to for my liver scan

 

[Samemka]

I googled about fasting because I wondered if thats why my bile acids came back as 9 once when I was insanely itchy (as they'd been 13 previously when I wasn't itchy in the slightest?!). I found that if anything fasting should make the result less, not higher, as when you eat more bile is produced to help you break down your food.

Louise - ask your hospital what their 'normal range' is for bile acids and if you're even 1 over that, demand to be induced at 37 weeks. Mine is 0-14 so I was prepared to fight them when they booked me in for 39 weeks, but as it was they came back as 9 (which to me is ridiculous because out of all the tests I've had over the past 4 weeks that's been the lowest result yet I'm itchiest now!). If they would have been 15 there'd have been no way I'd have waited until 39 weeks. I'm not convinced I have OC this time because it's no where near as bad itching as last time, but something must be going on because of my rasied LFTs/bile acids (google says the average bile acid level for a pregnant woman is 6.6). If I knew I had it and my results said so there'd be no way I'd have waited past 37 weeks - they wouldn't have had a choice because all the guidelines stress the importance of delivery at 37 weeks for confirmed OC. What have they said about 38 weeks? Get a second, third, fourth opinion if needed......there's no way if your bile acids are raised you should be waiting. I'm not trying to worry you, just saying that you shouldn't HAVE to fight this because it shouldn't be open for dispute, hospitals can be so stupid sometimes!!!

 

[louise1302]

im seeing my consultant again a week on weds so am going to see what my levels are and discuss it again i want to be induced at 37 weeks(not because i want my baby i 2waited until 42 weeks for archie) but because im scared of any risk to him

do the steriods for lung maturity cause sore boobs lol ive got up this mornign and they feel like pp boobies theyre so sore and massive-ouchies

 

[Samemka]

I've never had the steriod shot I'm afraid so can't say

I don't think you'll have trouble with your consultant - if he sees your levels are rasied he should be happy to induce at 37 weeks because of all the guidelines/research about OC. I was worried about seeing mine but he booked me in to be induced on Wed without even seeing my bile acid results, based on previous OC and similar symptoms this time!

 

[louise1302]

thats pretty good of him, i didnt see my consultant last time i saw one of his underlings and she was insistant it was policy to do it at 38-well sod bloody policy am definitely going to speak up. will probs take dh with me to speak up on my behalf lol im such a wuss

gl for your induction i bet you cant wait to get baby here x

 

[aafscsweetie]

good for you for speaking up! i'm sure 38 weeks would be fine as that's still in the safe realm, but i would be insisting on 37 just to be safe too! maybe print out the research from the medical journals to take with you?? i know it all says 37 weeks. you can find the links on the first page of this thread.