Obstetric Cholestasis Monitoring - Covid

[user1487755366]

Hi
33+6 with DCDA twins. Yesterday I was diagnosed with obstetric cholestasis. My Bile Acid levels are high (43) and ALT and the other one with an A at the start are slightly raised too). They did all the other function tests, scanned and monitored etc and also did a liver ultra sound and that came back fine. Babies seem to be doing well but because it's twins and they're quite squished in there it's quite hard for me to tell their movements apart.

I was told yesterday that ordinarily they would ask me to go in every week for bloods, monitoring etc. but that this isn't happening at the moment because of Covid for people who have my Bile Acid levels. Instead I would get a weekly phone call from community midwife about my symptoms (which are totally unbearable). I'm up almost all night sobbing because the itching is so awful. My urine is also much darker and yellower than normal. I'm scheduled for delivery at 37 weeks anyway because of it being twins.

I said I wasn't happy with the lack of blood monitoring as I know bile acid can rise and I'm approaching 34 weeks where that can affect babies. I'm due another visit to the ante natal scan on Tuesday and will be asking for them to measure my blood levels again and keep a closer eye. Just wondering what's happening elsewhere and for other people?

[KinderWild]

Hi - I am only 14 weeks but had OC/ICP with my first. I would be concerned at the lack of blood tests as bile acids can change in a short period of time are there are guidelines for delivering early if they go above a certain level. I also had very few/no itching symptoms when I had OC so not sure that is a good measure.

In my area blood tests are taking much longer to come back - my last bloods took 10 days. I haven't been told what monitoring I would get later on.
There is a charity called ICP support. They have a very active private Facebook group. The CEO of the charity is actively involved in research and gives amazing advice on the latest guidelines but also gives the info you need to advocate for yourself. Just thinking this may be helpful to you.

I ended up with an emergency induction last time as my oc went undiagnosed and my levels were sky high. I am speaking to my gp in advance about doing my blood tests if the midwife/hospital service is stretched because of covid. Xx

[giletrouge]

My daughter had OC and was monitored and had bloods done every week - had baby two weeks ago. I would have thought with twins they'd be even more vigilant.

[Doubleyikes]

I second contacting ICP support.

[youdidask]

I'm having sympathy itches for you OP.

I was prescribed piriton and menthol cream to start with and then an drug to lower bile salts but my levels were sky high.
I was induced at 35 weeks and I only had 1 baby.

You will also have to be careful about what hormonal contraceptives you have later on.

I'd be pushing for more checks personally, I'd also be asking for more help with the itches.

I really feel for you

[PeaceAndHarmoneeee]

I had ICP and would be very unhappy about the lack of blood tests and monitoring- your midwife isn't going to know how high your bile acids and LFTs are just by chatting about your symptoms as the symptoms are in no way indicative of your levels.

And if your bile acids and LFT results are not good you need to be induced for the babies wellbeing- again, the midwife can't tell how high they are from a chat.

I had to be induced at 35 weeks cos my bile acids were over 40 and not going down with medication. But I actually felt less itchy than I had in weeks.