Obstetric cholestasis - 2nd pregnancy

[susanita]

I?m 32 weeks pregnant with 2nd baby. I was diagnosed with Obstetric Cholestasis right towards the end of my 1st pregnany. I hadn?t started itching until about 37 weeks and, despite going to the hospital 2-3 times after talking with midwives, the doctors at the hospital felt that I couldn?t develop OC so late. It was only after seeing a midwife for a routine appointment who, after seeing me scratch myself furiously, referred me to another midwife who liaises with consultants dealing with OC that I was told that doctors had overlooked abnormal blood results and I had to be induced that day as it was dangerous for the baby ? I was 2 days over the due date.

I am being monitored by consultants this time and having blood taken once a month. I?ve been given guidelines as to what I should do the moment the itching starts. I know that the same oversight cannot happen again but I?m feeling really very anxious now. At what point did other mothers start itching and when were you induced? How did you cope with the itching? I just remember that incredible itch that wouldn?t let me sleep, scratching myself until I bled and I?m not looking forward to the high probability that it will happen again. I?m also not looking forward to being induced again although I guess that not having some of the surprise/shock of the first time around will hopefully mean I won?t be so stressed. I guess I?m still mad that I just knew something was wrong, kept seeing doctors and then being told that results were overlooked and I had to be induced immediately to save my baby?s life.
Sorry to ramble on, I?m just a little scared now I?ve reached the final stages.

susanita
First Don't worry. I also had OC, and the main message I got was that once you knew about it you are OK.
Mine was discovered at 32 weeks - after I told my doctor that I thought I had it and insisted on the LFT's. I was induced at 37 weeks. The danger time is after 37 weeks - apparently the risk of stillbirth goes up to 20% after this.
I was put on a drug called ursodeoxycholic acid as soon as I was diagnosed. Apparently this brings down the level of bile acids in the blood. However as the pregnancy progresses it is less able to help, hence the induction. It also helped with my itching, but apart from that just symtomtic treatment-lots of emmolient cream to stop the skin drying where you've scratched, cool baths and showers, nice cold sheets and a fan in the bedroom all helped me.

I have details at home of a support group - I'll post their number later.

Poor you, Susanita.
I unfortunately suffered this condition with all my pregnancies and it's truly awful. Even with the last pregnancy the itching kicked in at week 35. The profound itching on the soles of my feet and palms of my hands drove me absolutely demented. I believe it can even start as early as the second trimester.
Prufrock is absolutely right. Your liver function tests should be monitored closely and they normally recommend induction at approx 37/38 weeks.
Good luck.

The OC Support and Info line is 0121 353 0699. It's run by a lovely midwife, based in Birmingham I think.
Theres more information here ,

and this website from the US. itchymoms

Many thanks prufrock for all the info. Thanks as well efmach. Although you get all these reassurances from the doctors, it's somehow comforting to chat to other women who've been through the same.

Hi Susanita - I had cholestasis with pregnancy number 3 (although I'm sure I also had it with number 1 and it just wasn't diagnosed). For me, the itching started at about 20 weeks and tended to be tops of arms, chest and back. I found the ursodeoxycholic acid worked very well and there were no further problems. I was induced at 37 weeks and feel it was more painful than going into labour naturally: I had to have an epidural and just made do with gas and air for my second birth.

But the birth was OK, and all the liver function measures went back to normally pretty quickly afterwards.

Best of luck - I'm sure you'll be absolutely fine.

Hi susanita, I had OC in my 3rd and 4th pregnancy. It was diagnosed at 35 weeks the first time and after a lot of faffing about and 'sacking' my consultant my little girl was induced at 38 weeks and she is absolutely fine! When I got pregnant the last time, my new consultant was really on the ball and I started the oxy-thigummy acid at 30 weeks which did seem to help with the terrible itching. He also told me that it was almost certain that I would continue to get OC with subsequent pregnancies with the risk of permanent liver damage to me so my dear hubbie had the snip when I was 35 weeks gone. I was induced at 37 weeks and had another beautiful girl who does have a condition called craniosynostosis but that was totally unrelated to the OC. Incidentally, the itching started much earlier in this last pregnancy at about 22 weeks. My girls are 22 months and 4 months old so it all happened fairly recently. Hope you feel better soon. Take a look at the itchymoms site if you like but there are some very sad stories on there and to be honest they scared me quite a bit! Good luck..smileyjo xxx

Maybe I'm being neurotic but I woke up this morning with a rash on my arms and legs and itching. I went to the doctor who said she thought maybe it was an allergic reaction to something. I came home but the itching has woken me up tonight and is unbearable, especially on my hands and feet. My palms are very red and my hands are aching from scratching them so much. I had athletes foot a couple of days ago and so I wonder if that's what's causing the foot itching. I've just used some spray on that so maybe it'll ease (it's working already, my feet are feeling better) but my hands and arms are still itching and the rash is also still there. It seems from looking at some internet info that itching on the hands and feet can be a symptom of OC and it can start as early as 2nd trimester. I'm 18 weeks. Any advice? (apart from go to doctor which I will first thing Monday) Should I ask for the liver tests for OC or am I being over dramatic and dangerously self diagnosing? TIA.

www, I'm sure you'll have more accurate responses from the medical experts and midwives, but my understanding is that OC is important to spot, but is actually only dangerous to the baby during the last few weeks of the pregnancy. You should definitely get your gp to test you on monday, but you've got quite a bit of time to find out if you've got it before you have to worry that they haven't acted quickly enough.
But, having said all of that, I got a horrific rash and itching (up all night and bleeding I scratched so hard) for the last 2 or 3 months of my first pregnancy that turned out to be PPPP (or called something like that...it had lots of P's). Anyway, it wasn't harmful to either me or the baby ("it just happens sometimes during pregnancy" so my gp wasn't very helpful in making the itching stop. Her great informed suggestion was Calamine lotion (as if I hadn't tried that already in the 2 weeks before I got to see her). I found that Rose's Prickly Heat Powder from Hong Kong worked better than anything else. If it turns out you don't have OC and just need to get rid of the itching let me know and I'll send you what I've got left.

www, i was plagued with rash/itching during months 3 - 6 of my pregnancy. like sofia, was told it was "just normal pregnancy itching". definitely go to your gp and get checked out. if it turns out not to be OC, i recommend aqueous cream (available from pharmacies). is there no end to the misery of pregancy? take care.

Thanks you two and I'll take you up on that offer SofiaAmes if it turns out I need it. I looked up PPPPPPPP or whatever it's called in the middle of the night too and that doesn't sound nice either, but better than OC. Let's hope it's neither and just allergy/normal itching. My eyes are puffy this morning so I might try getting some Piriton and see what that does (dr says it's fine) Checked with my mum and no history of OC so let's just hope I'm being neurotic! Yes, it's only the last few weeks OC is a problem but it means early delivery so I really hope it isn't that.

www. Really hope you haven't got this - but as has been said no reason to worry at this stage even if you have. Get the Liver Function Tests, get your urine checked for Bilirubin (also an indicator, especially at this early stage). If all tests are normal, but you still itching by 28 weeks, insist on a Bile Acid test. On the positive side, if creams/sprays are making the itching feel better it is unlikely to be OC - nothing stops that itching!

Thanks prufrock, the itching has stopped and the rash has gone so I guess it was an allergic reaction and I don't have OC. Too much reading about pregnancy related problems is definitely bad for one's health!

www - I am really pleased for you. I too suffered from agonising rash and itching in last 3 months of pregnancy ... liver test came up clear, and medical professionals were disinterested and unhelpful regarding the pain I was in ... They told me it would disappear within minutes of giving birth - which it did! (after months of discomfort) Anyway, glad you don't have to go through that.

Hi,
I am 22wks with baby no.3. I was diagnosed with OC at 34wks in preganancy no2, (although i had with no.1 as well). I have now started itching and i wondered if anyone else out there has developed oc at such an early stage. Is it safe to take ursodeoxycholic acid for so long and does it continue to work for so long?
Also OC is itching without a rash. Although the scratching soon makes your skin bleed.

I had oc at 22 wks with my first baby (Stillborn) due to other complications so please try not to be alarmed. Medication and lots of checks on my bile acids, medication shouldn't really be taken for a long period of time, I would advise you to talk to your consultant about being induced around 34wks as this will help your baby and yourself. I had the itching but no rash. . (I also had a second baby no oc but went into labour at 24wks, lost baby) the doctors have told me that if I get pregnant again I shouldn't suffer with oc. best of luck, hope all goes well for you go and see your doctor as soon as you can to get bile acids checked

I'm 38 weeks and the hospital "think" I have OC. I'd hoped for a homebirth until I started itching, but since the first available induction slot is Friday week, I'll probably be desperate for anything to make it stop.
Does anyone have any advice on coping with the itching and lack of sleep?

They "think" you have OC! Don't accept that. Have they done LFT's and bile acid tests?
If you do have OC they shouldn't be making you wait a week for an induction. At the least they need to be monitoring you in the meantime. And if you don't have it they shouldn't be scaring you like this.
Call the OC helpline on 0121 353 0699 to get more advice - they are really lovely.
For the itching - Ursodeoxycholic acid pills can help - your doc should be prescribing these anyway. Try wrapping your hands and feet in cold towels and plastic bags before you go to bed, and don't overheat the room.

They did tests yesterday and from reading my notes the levels certainly seem high. I'm going back this morning for monitoring. The hospital was being perfectly sensible until my consultant turned up and started talking to me like an idiot, but he always does, and by that time I'd been hanging around for seven hours. The baby was OK and it looked like they were too short staffed to do an immediate induction. I'll see what they say today. Consultant didn't offer pills, just recommended calamine lotion.
All this is why I'd planned a home birth, but obviously induction is looking increasingly attractive now

Dannie that is such crap.

Calamine doesn't work, any consultant worth his salt should know that. The OC itching comes from inside, so topical applications to the skin don't do anything.

The figures they will look at in your notes are the transemanine levels from a LFT (over 45 is an indication of a possible diagnosis - mine got over 200 at one point!). IF they've done a bile acid test (unlikely, it takes 3 days for teh one lab in Birmingham to do this) 10+ indicates OC.
Good luck with the monitoring. My consultant was happy to monitor every 2 days at the end - if everything was OK and the baby was moving about lots they were happy I was safe. But it really isn't worth running the risk at this late stage. All experts recommend inducing at 37 weeks if you really do have OC - don't let this crappy consultant fob you off.

Oh he's a marvel, but I've already moaned about him elsewhere on Mumsnet. Thanks so much for the info, I'll run back up to the hospital now and hope he's not around and I get sensible people instead

Hi Dannie, how are you and what happened at the hospital yesterday? Wondering if they will bring forwrad the induction?

I'm having daily monitoring and their latest offer is an induction on Tuesday. Must say it's a better birthday than Hallowe'en.
The hospital doesn't seem very familiar with the condition and the staff seem to assume that because I wanted a homebirth I'm some kind of hippy troublemaker who'll refuse all interventions. I feel like I have to keep telling them my priority is a healthy baby. Plus since they haven't given me anything for the itching, I just want it to be over while I still have some skin!

You poor thing Dannie.
TBH, if they are doing daily fetal monitoring they will pick up any possible problems. And Urso would take more than a couple of days to have any effect on the itching (if then). Of course, if you really are desperate you could tell them you've noticed a reduction in the babies movements - that should get them worried enough to induce you today
Good luck

Can I open up this thread again? I've posted on several threads over the past week, and I'm getting desperate. I'm 9 weeks pregnant and have been plagued by an awful rash for the past week, which itches like crazy and is driving me mad! It's on my face and neck, arms, legs, back and bottom. Heat makes it worse.I've been particularly careful about what I ate yesterday, as some foods seem to make it worse. The rash was much better first thing this morning, but my hands and feet were frantically itchy, and now the rash is starting to spread up my legs and over my bottom again. Calamine doesn't touch it - just seems to dry out my skin and make it even more itchy. I saw the doctor this week, who thought it was a reaction to pregnancy hormones (it's my 2nd pregnancy, but I had nothing like this in the last one). Is this OC? Can it start this early? Will it go away, because I'll end up mad if I have to put up with this for the next seven months!!

It shouldn't start this early in pregnancy,If I was you I would go and see your midwife or ring the hosptial and ask them for some advice because you need to catch this early with some form of medication. If your hands and feet are red and beginning to get sore then I would advice you to see someone, It could just be your body adjusting and all the hormones kicking in, but to put your mind at rest ask a professional for some help. I did have oc with my first, who was born asleep but that wasn't due to oc so please don't panic yourself, It can drive you crazy, but once they find out it is then medication helps. As you are only 9wks I haven't heard of any cases this early. hope this helps. Sorry I might have rambled.