Obstetric Cholestasis - anyone else got this?

[KiwiKat]

I had OC in my first pregnancy, and was feeling very pleased that it hadn't developed this time, but it has suddenly popped up at 32 weeks. Bum, bum, bum!

However, at least I know what to expect this time. Anyone else going through this?

Hi,

I'm 31 weeks into my second cholestasis pregnancy and have a very clued up consultant which really helps.
My first pregnancy I was disgnosed at 35weeks but this one at 24, early 30s is the normal time for it to appear but it can come anytime, earliest I heard of was 16 weeks.
Guidelines have changed recently but are still open to individual interpretation so delivery dates can vary from hospital to hospital but you wouldn't be allowed to go over 39 weeks and its usually 38, I'm on URSO and go in to day unit once a week for baby monitoring, blood tests and to see my consultant, they check my liver functions and bile acids however bile acids are only done in more specialised labs so not everyone has them done.
Best thing for the itching is.... get a karge tub of aqueous cream, a bowl and a tub of Vicks vapour rub, mix a heaped teaspoon of Vicks into the tub of cream and keep in the fridge, heaven , recommended by the dermatologists at the hospital and really good
Good luck with it, try not to let it stress you out too much coz that makes the itching worse, it ruined the end of my 1st pregnancy and despite things being a lot more up and down with this one I am absolutely not going to let the dsame happen this time

or large tub even

I'm 33+4, and was tentatively diagnosed at 31 weeks, and the symptoms kicked in that weekend BIG STYLE! I'll be having weekly tests and consultant visits from now on until the birth, with a fortnightly scan. Took about 3 days for the drugs to get on top of the itching, and now I barely notice it.

Thanks for the tip re aqueous cream and Vicks, Squally - if the itching intensifies, I'll be giving that a go.

Nice to be able to talk about it to other people going through the same thing, as those who haven't experienced it just can't seem to get their heads around how frustrating it can be.

Hello SquallyRose, thanks for sharing your story too. I have my GP appointment in the morning. Hope she listens. Can I ask, what do the consultants look for at the weekly appointments, information on OC seems so scarce.

Off to bed now, used to love curling up in bed at the end of day but have begun to dread it this last few weeks. Hopefully tonight will be an easier night :)

Ok,

saw the GP and she was very sympathetic and seemed to know a lot about OC. But, she said, eve if my Bile Acids weren't at dangerous levels last time, they would expect to see some elevation (as its the bile salts that cause the itching) and mine were only 2!!! Despite this she agreed to test my bloods again to be sure and prescribed me some piriton which apparently has some sedative in it as well so may help.

So it looks like my problem is genuinely hormone related rather than OC, can't imagine what you ladies are going through, this is miserable enough.

Thanks again for your help and advice

Just a note, the '2' was taken at 25+3, I should get today's results back tomorrow, I'm now 28+5

The important thing is that you keep getting rechecked, but it sounds like your GP is supportive of that strategy. It'll be good to get the levels of your latest test to see if they have risen - seeing the rising trend in BA levels was what led to my diagnosis with only borderline levels.

Piriton can help you sleep, yes. I take it and it was recommended by the DAU even though they said it wouldn't do a darn thing for the itching! Getting enough sleep is very important to keep you generally healthy and keep your bp down.

Lots of sympathy for you poor itchy ladies

I had OC with DS2, I had the blood test for it at 35 weeks but heard nothing back, and not knowing anything about it I didn't chase them for thr results.

I was 42 weeks before I happened to look over the MW shoulder and see it written there in big red captial letters

I was rushed through to be induced straight away, had a scan etc. I had no idea what was going on, it was only afterwards when I did some research that I realised how dangerous it could have been.

Does anyone know if you are more likely to get it in subsequent pregnancies?

Yes, you're more likely to get it in subsequent pregnancies unfortunately. It's not definite - some people escape! - but it's something like 90% chance if I remember right.

I'm only 6 weeks at the moment and still in denial really - don't want to get my hopes up yet so trying not to think about it really.

Will make sure that I mention it repeatedly to the MW when I finally see one.

At least the itching does always seem to be the first sign, so it's not that you can miss it entirely. But definitely make sure you're getting your BA levels checked every 7-10 days if itching does start.

I saw the specialist today for my weekly tests etc, and she has scheduled me for a c section at 38 weeks, on Friday 12th.

Then she rang this afternoon with today's results - she said that my bile acid, which should be no higher than 14, and they had got down from 12 to 9, was now 25! Not good. Ironically, my itching has nigh on disappeared, and I feel better and am cheerier than I have been for ages ... She said it was a pity that the midwife had dismissed my earlier request for a blood test, as we could have got onto it earlier, and probably had it under control earlier - PUSH to have those tests!

(She said that I can recommend anyone with questions to get in touch with her - Margaret Keenan at the Foetal Maternity Unit at the Royal London Hospital. She's FAB - jsut so down to earth, courteous, makes sure you understand everything, and treats you like you're the most important person in the world.)

So I'll have to bump up the Urso, and I have to go back to see her first thing in the morning for another round of tests. Just goes to show you how quickly things can change - make sure you all keep a close eye on your own test results.

Oh no *KiwiKat, that's not good!

Thanks for the specialist recommendation. I'll bear it in mind for when we see the local OB consultant next Tuesday. So far the RBH have been brilliant with this and even the SHO in the DAU was up on OC research, so I'm hoping they're up to dealing with this properly. But it's nice to know who to go see if not.

Off for more bloods Friday!

Hi,

readyornot2011, at my day unit I go on the ctg monitor for half hour, this checks the babys movements and heartrate etc, I have bloods done, full blood count, liver tests and bile acids and I am also having growth scans once a month. The consultant said there is no evidence OC causes growth issues but as there is still relatively little known about it he feels happier checking everything.
What you've been told isn't necessary true about the bile acid elevations, cholestasis can be diagnosed on any of your liver levels being wonky, did she tell you what your alt's were? My consultant said if any of your liver function tests were abnormal, you had itching and they couldn't find any other reason for it you would be considered to possibly have OC and should be treated as such, both times once my alt's went above normal I have been given a full blood screen for things like hepetitus and other liver issues and a liver scan to rule out any other issues bfore cholestasis was mentioned although this time I knew what was coming!!
With my previous pregnancy my alt's were over 150 but my bile acids never went over 4.9 which is well in the normal range of under 14, I would definately keep up with the blood tests as it its so much more treatable if they can get an early diagosis.
Interestingly thing pregnancy it seems my alt's are staying lower and bile acids going up, still under 14 at the moment but increasing weekly, the upward trend is currently more of an issue than the actual levels, increased URSO to 1 gram daily and hoping that helps, consultant is still hoping he can get me to 37 weeks but said based on next 2 weeks results if it looks likely I'll need to deliver earlier they'll consider giving me steriods to mature baby's lungs, eek!!

Morning everyone,

No word from the doc yet, but I am happy to report I had my first reasonable nights sleep in weeks after taking the Piriton last night. Still itchy but so sleepy it didn't bother me as much. Was so surprised when I woke up at 2.30 and had missed my superitchy period (12-2) felt itchy at 2.30 but managed to get back to sleep reasonably quickly.

Did have a heart stopping 20 minutes or so this morning waiting for the little one to wriggle, usually I wake up to it or if not DH strokes my belly and she wakes up. But this morning nothing, despite lots of rubbing. I was convinced I'd killed the poor little thing but massive relief when she finally kicked and now she wriggling round like normal. Phew.

Really hope you can get to 37 weeks SquallyRose sounds like they are taking great care of you.

The Piriton is really helpful in getting to sleep despite the itching. Glad it's doing something for you.

The Urso seems to really be kicking in for me. I'm still a bit itchy, but I managed to have a bath yesterday without it making me worse (heavenly!) and went to sleep no problem without Piriton.

Good news Japhrimel bath makes me worse too must be the heat.

Ok so the doctor just called and all my levels are totally normal, she read them all out to me as well as the normal ranges and they were all well within. Bile Acids were 2.4 so no change and very low. I think she said ALts were 14? Anyway none of them were anywhere near raised.
She said the sedative in the piriton may have affected the baby a little but not to worry and they dont recommend it near the EDD because of that but fine now.

So all in all looks like I'm fine which is a relief, in fact everything seems rosier after a good nights sleep. Good luck ladies, I hope the docs keep your levels under control and you get the births you want. Thanks again for all your help x

Glad it looks good.

Do make sure they retest in a week or two if you're still itching. For the hassle and small cost of a blood test, it's just not worth risking missing OC.

Your LO may also have been sleepier because you slept through. I no longer get woken up by baba kicking, but if I have a restless night, so does she.

Aaaagh - the itching is back! My hands in particularly are driving me crazy. I think I'll have to ring the consultant tomorrow morning, rather than waiting for the scan and tests on Thursday. Blast!

How's everyone else doing?

Hi all,

I am not pregnant but was lurking and found this thread. I feel for you all. The itching associated with cholestasis is unbearable. If you have not experienced it, you will never know how bad it can be.

I began itching when I was around 36 weeks pregnant. Because it started on my bump it was put down to hormones. I then started to gradually itch all over my body. At 38 weeks pregnant my bile levels and liver function were tested and the bile levels came back as borderline. The test results were not back until I was 39+6 weeks pregnant. A decision was made for me to be induced at 40+1. I went along with this as I couldn't bear the itchiness any longer.

I found night time worse - probably because I had nothing to occupy me. I found that having a warm bath, drying off properly then slathering myself in aqueous cream with calomine helped for a while. It usually helped me for long enough to get to sleep if I managed to get into bed right after my bath.

The lowest point for me was when the itchiness spread to my back...awful but luckily I had a lovely DH to scratch it for me.

Sorry for my useless post, just saw this thread and felt really bad for you all. Hope you are getting some sleep.

hi there, ive never heard of this before, i was looking around the pregnancy, conception,mc threads as i recently suffered a mmc.
For the last yr ive suffered ichy feet,hands and on rare occations arm pits!????
The itching has got worse since my mmc 5 weeks ago?? Is it hormone related??
Also this wouldnt have anything to do with my mmc?? I was 1y weeks but lost baby at 8. Any advice would be helpful, thanks ladies x

If you've had long-term itching issues, one of the things that should be checked out is your liver. Have you seen your GP about it?

No as i just assumed it was my body over heating as it normally happens in bed...
Will get it checked when im next pg, fingers crossed. x

Bile acids back down (!) to 17 and the itching has diminished somewhat, so whilst not ideal, it's looking better. Whew.

How is everyone else doing?

Bile acids up to 18 (was 12 before starting Urso 10 days ago), but LFTs are still okay, if near the high end of okay. I'm to get weekly bloods for BA, LFTs and clotting and to see the antenatal clinic again in 2 weeks.

I'm 33 weeks tomorrow, so although the doctor didn't want to discuss possible induction yet, I can see that if my BA levels continue to rise, we could be booking a date at the next appointment. I know the risks are definite/highest if BA levels go over 40, but if my levels are steadily rising, I'm not happy going beyond 40 weeks, if that far.