Obstetric Cholestasis... any experience?

[2sCompany]

Hi All, I am currently 36 weeks pregnant with DC3 and due to itchy hands and feet have had blood tests to check my bile acid levels. They have come back at the high end of normal - 13, when the normal range is 0 - 14 apparently.

The hospital have told me to have more bloods taken next week in order for them to retest the levels, also to keep an eye on the baby's movements. I presume this is in case of the risk of Obstetric Cholestasis.

Just wondered if anyone had any experience of Obstetric Cholestasis and what the implications are for the baby. There seems to be conflicting information as to whether it means a higher risk of stillbirth or premature delivery, or if I simply have to put up with the itching!

I would be very grateful to hear of anyone else's experiences with this please

[starkadder]

Hi there

Yes - I unfortunately have experience..! I had OC with my son and now have it again (am 34 wks with this pregnancy).

The OC Support Group has some really good info on their website.

It has been thought that there is a higher risk of stillbirth if you have OC but only if it is not diagnosed and not managed. Ive seen some research which actually says this theory has been discounted, and the risk is no higher - but I am not sure where the new stats came from, since most women with OC are now medically managed anyway.

They generally induce at 37 or 38 weeks to avoid this higher risk. Also, they'll probably put you on ursodeoxycholic acid, which brings the bile and ALT levels down.

Plus my hospital has asked me to come in for weekly monitoring and to keep a special eye on the baby's movements - hard for me as I am inclined to paranoia, the placenta is at the front, I'm working more or less full time, and have a 3 year old - so keeping an eye on movements is a challenge to say the least. But I do try and make time to sit or lie down calmly and check I can feel her jiggling about in there every now and again.

So I woudln't worry too much about the baby - as long as you've been diagnosed and everyone is keeping an eye on you.

Now....the infernal itching...

I am on the urso acid at the moment and I have to say, I haven't noticed much improvement in the itching.

But, you're allowed to take Piriton for the itching...make sure you get the "drowsy" kind..! This helps a *little".

I have found that both aqueous cream with calamine in it and aqueous cream with menthol (you need a prescription for the menthol one) can help very temporarily with the itching. And if mine gets too bad, I run a bath, put oatmeal in it (about one cup of oatmeal in a tied up muslin or chopped off end of pair of tights) and jump in - that really helps - again, temporarily, but enough to get to sleep.

Good luck with it all!! If you are 36 weeks you won't have too long of the itching anyway:) I envy you...! I have at least 2.5 weeks to go and am getting not much sleep...

[2sCompany]

Thanks for the reply... the itching is driving me mad today, it seems to have spread all over now I've been boiling hot for the last couple of days too, which seems to make it worse. Don't know why I'm heating up, as the weather is cooling down!

I haven't been formally diagnosed with OC, but they have asked me to do another blood test this week so at least they are keeping an eye on things just in case. And my midwife suggested calamine lotion when I saw her last week.

I know what you mean about not being able to keep a good eye on the baby's movements - I have a 9yr old DD,2 yr old DSand 13yr old SS all keeping me on my toes at home and I'm never sure if they baby is quiet or it's just asleep with me moving about all the time!

Again, thanks for the reply - I will definitely give some of your itching remedies a try!

[NoobyNoob]

So sorry you have this, it's the most annoying thing in the world.

I had OC with my last, and it sounds a little pesimisstic, but I'm waiting for it to kick in with this one too! (25 weeks today)

With me, It appeared around 33 weeks. I was sent to the hospital for monitoring every week up until a week before my due date when I was induced. I was given some sort of cream which had a menthol cooling agent in it which really helped, I also took Piriton but that didn't do anything.

Once DS was out, it went away completely, but was always told that there was an 80% chance of it in subsequent pregnancies. Which is shit, because I really, really don't want to have it again.

I hope you find some relief soon x

[starkadder]

:) my itching terrible today as well...grrr....it does drive you crazy, doesn't it? but at least we know it is only temporary.

[2sCompany]

I would say it's good to hear others are in the same boat, but I really wouldn't wish this itchiness on anyone, so it's not really good but reassuring IYSWIM !!

Also, glad to hear you both had good outcomes with your first pregnancies despite having OC. This is my 3rd and final, so I think I've been very lucky to escape it so far. I really don't know how much longer I can put up with it though, even though I'm nearing the end... can't sleep or sit still and I'm knackered!! I feel so sorry for you starkadder with longer to go than me. And NoobyNoob I have everything crossed that you don't get it again this time round!

More blood tests tomorrow and nearing the magic 37 weeks, so fingers crossed for a positive outcome soon

[2sCompany]

Well, blood tests and more blood tests... each time my bile acids are climbing. They're up to 17 today.

Hospital don't seem to know which way is up; most people are telling me they won't induce and will just keep monitoring until my due date. One midwife today said they will want to make a plan to get me induced sooner rather than later. I'm due to see a consultant on Wednesday.

I'm not happy with this 'watch, wait and see' attitude. They have said I need to go in twice a week to be strapped to the monitor, have regular blood tests and I need to keep an eye on baby's movements. They've given me all the meds - Urso Acid, Pirotin and Vit K, but I'm still itchy and as I said, my bile acids are still increasing. Whilst I'm glad they're keeping an eye on me and the baby, I just want to make sure the baby gets out safe and sound instead of waiting for something to go wrong before they'll do anything about it.

Can I make them induce me? I'm past 37 weeks now. Just so frustrated that I can't do anything about this and worried that even though my BA levels aren't mega high, they are still increasing.

Any advice about what I should say to the consultant on Wednesday would be gratefully received, I am hardly sleeping between the itching and worrying and trying to make sure the baby is still moving.

[2sCompany]

Please... does anyone have any advice at all?

[TaffyandTeenyTaffy]

I had it, but much earlier on than you and my DS was born at 33 weeks because my levels were off the scale... I was told that they would let me go to 42 weeks before inducing - that was the evening before I was called in for them to monitor me on the ward for a couple of weeks/adminster steroids etc. at around 30 weeks!

I seem to recall that my levels were 90+ and 45 was the maximum safe level before they would even think about inducing, but I may be wrong/that may have been because of my gestation - but its worth asking what level you would need to get to before they will induce.

Just make sure that they are monitoring you regularly and tell the consultant your concerns - and if you are not happy go back and see your GP/midwife - my hospital were fab and I hope you get the answers you want tomorrow - oh and that the itching eases.

[2sCompany]

Thanks for your reply TaffyandTeenyTaffy. That's a good idea to ask what level they normally induce at. My normally organised brain has failed to come up with such a logical question.

I feel like a bit of a fraud, complaining at this stage - sounds like you had it a lot worse than I do. I'm just confused with getting different information from each different person I see. And I'm not very good at this 'wait and see' malarky, I like to have proper plans in place! Everything feels out of control and all I'm concerned about it making sure the baby is safe and well, which at the moment seems to me like it would be better out than in

[TaffyandTeenyTaffy]

Dont be so silly - It's a horrible condition and as its fairly rare people dont know much about it, so can't really sympathise or offer any advice in RL. The risk of having it again has put me off having any more children!

The good news is you will feel instantly a hundred per cent better when baby arrives .... I was full of life and energy and people said that I looked really well (I must have been looking really shit before, as well as feeling it!)

[starkadder]

Hi there

It is awful waiting - poor you.

Bile acids of 17 are raised but not that high, I don't think. Mine are 110 at the moment, for example, and they plan to induce me next week (when I'll be 37 wks).

I still think you should push for an induction anyway though. I am sure you and the baby will be fine (my consultant told me today that he has not seen a case of stillbirth when OC has been diagnosed - only when undiagnosed and they are looking for stillbirth reasons after the event, if you see what I mean) but, apart from anything else, the constant itching and stress is just awful.

[2sCompany]

Hi again starkadder

I know my levels aren't super high or anything, goodness, yours are in the 100s, so I can't imagine what a worry that is for you. But you're right, it's just the waiting and not knowing that's the worst part, especially as I seem to be getting conflicting information from all sides. As I say, I would feel safer with the baby out rather than in at the moment, so I think I will push for an induction with the consultant tomorrow. I'm sure the lack of sleep and stress can't be doing either of us any good anyway!

Good grief I'm a right moaner aren't I?! I know there are people with far worse worries than me .

Thanks everyone who has replied for your help and reassurance x

[TaffyandTeenyTaffy]

Hi 2s company.... how did it go today? Hope you got some answers.

[2sCompany]

Hi TaffyandTeenyTaffy... yesterday was a hell of a day. I went to see the consultant, who just laughed at me and told me not to worry. They won't even consider inducing until I'm 40 weeks and in the end made an appointment for when I'll be 40+3 to discuss inducement. She said they see OC all the time and the drugs will manage it so the baby is better off in than out. I didn't feel she listened to me at all. They may see it all the time, but it's new to me and I can't just switch off my feelings about it all because she says so. So I somehow ended up in tears and being sent off for yet another CTG monitor which I had to wait another hour for. That was all fine and the midwife said the baby is very engaged, so fingers crossed that's a good sign too.

Anyway, so they upped the doseage of the urso and vit K. I'm to go back for another ctg on saturday, scan and bloods on wednesday, something else on friday... I have about a million appointments over the next few weeks, I can't even remember what they're all for. I am glad it's all being monitored but I'm just feeling exhausted and emotional about it all and it doesn't help at all when the professionals just wave me away telling me not to worry and they see it all the time.

Sorry for the long whinge, I'm feeling really down today. Just back to the 'wait and see' game, which I hate.

[Cherrybug]

2scompany - just a bit of sympathy from me. I had OC with my DD and was induced at 39 weeks but my levels were apparently extremely high so they wouldnt give me a choice.

I'm now 37+2 weeks pregnant and have a midwife appt today where I'll get bloods taken. Im getting a bit itchy but not crazily so, like I was last time so hoping bloods will come back normal. From what I can see different hospitals have different ideas when it comes to inducing. They wont induce unless the risks of OC outweighs the risks of induction and if your bile acids are not too high it's probably safer to keep baby in on balance.

The good thing is you are being monitored and treated so try not to worry too much. And with the baby engaged you might go into natural labour anyway soon. I hope so, perhaps worth trying the old wives tales, sex, curry, pineapple, long walk etc.

Good luck!

[2sCompany]

Thanks Cherrybug. I know I'm probably worrying too much as my levels aren't all that high really. I'm hardly sleeping what with constant toilet trips, heartburn, blocked nose and being huge and uncomfortable!! Not to mention trying to run round after the rest of the family (I could swear they go around after me un-tidying things!) It's all messing with my head and making things seem worse than they really are I suppose.

We had a curry last night and I've been on the birthing ball most of the morning between doing the washing, so walking up and down the stairs a lot. Sex is right at the bottom of the agenda though! I couldn't feel less in the mood if I tried - DH said, 'I suppose you'll be pouncing on me 3 times a night to try and get things going' ...wishful thinking on his part, I couldn't pounce on anything if I tried, it takes me half an hour to turn over in bed these days!

Good luck with your blood tests this time, hope they turn out ok