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?

Sorry to hear that, Japhrimel. I hope your bile acids settle down. Are you still itching, or has that subsided a little?

Still itching, but it is a lot better than it was - now mostly at night again and I can have a bath without being driven insane!

C Section now rescheduled from 12th to 8th November, at 37+3. All ok, but they don't want to take any chances (and fair enough).

Just when you think you know what's going to happen next. Hmm ...

Oops - that was me. I had namechanged to ask a question about our crap solicitors.

How are you feeling about the new date?

Can I ask why you're going for an ELCS? Have you had a CS before?

Hi all. Have only skim-read thread, so apologies if I repeat what has already been said.

I developed OC in my second pregnancy (didn't have it in first).

I was about 34 weeks when I got insane itching on the soles of my feet. I had the bloods done for bile / liver function etc straight away and my results were pretty poor, so had to have twice weekly, then eventually every-other-daily blood tests, until I went in for a blood test at 37+5 and was told they were keeping me in and going to do a c-section the following morning. Bit if a shock!

I had to have a c-section because I had had a previous section and, although I'd been aiming for a VBAC second time around, the hospital I was at won't induce people who've had previous sections (lots of hospitals have this policy, I believe). If I hadn't have had a previous section, they would have offered induction instead.

There is a lot of debate about OC within the medical profession (as well as an awful lot of ignorance - some midwives don't know much about it lots of GPs are completely clueless). Some hospitals / consultants don't believe the early induction/section is necessarily the way forward with good monitoring. Other hospitals (including UCH, where I had my DD) induce or section OC mums betwen 37-39 weeks as a matter of course, because of a slightly increased risk of stillbirth.

I wasn't taking any chances and am glad UCH took it seriously. My DD was born a healthy 7 lb-er, with no problems, but was slightly jaundiced for a few days after birth.

it is a horrible condition, isn't it? None of the drugs they prescribed for me worked, and the only thing that gave 6some^ temporary relief was a cooling menthol lotion they gave me, applied to my feet after soaking them in icy water. I also found walking barefoot across cold, tiled floors in my kitchen helped a bit.

I've been quite fortunate to have it diagnosed at an early stage. I'd say I've been "lucky" but if I hadn't insisted the GPs check my BIle Acid levels, they wouldn't have done and I still wouldn't be diagnosed, so not much "luck" about it.

Only issue is that as it's been caught so early, there's more debate about what to do with me. A student MW in my last appointment said she'd seen 2 OC cases already, but both of them weren't diagnosed till 36 weeks and by then their bloods were so bad they went almost straight for induction!

I've been touch with the research team at Imperial and it really is unknown whether, if your BA levels never get above 40, the risks of going to full-term are higher/lower than the risks of early induction. So unless my bloods carry on climbing, I'm in a bit of a limbo position! Going to push to not be left to go beyond 40 weeks whatever though.

OC was diagnosed at 35 weeks in my first pregnancy, and they didn't get the bile acids under control, leading to a failed induction and emergency c section at 37 weeks. They don't bother with inductions if a previous one failed, as your body has no 'memory' of what to do, if that makes sense.

As well as the regular blood tests, I've had a number of scans to ensure that sufficient blood was moving through the baby's heart and brain, and even though it is, they've decided to give me the csection earlier. I'm fine with that, Japhrimel, as it's really only 4 days earlier than the section scheduled for 38 weeks - I'll be 37.3.

Before you read this next bit, be assured that because of the care offered, it's very rare to lose a baby these days to OC.

Ok, you can read on now.

It was only yesterday that I found out what happens (or more realistically, USED to happen) to cause the babies to die - the bile salts affect the heart chambers, causing something akin to aryhthmia. The scanning specialist said very little was known about it, and that they had been stumped when this would happen to a full size, otherwise healthy baby at 39 weeks, which is why then tend to deliver earlier. The good news is that the effects aren't long-lasting, and the babies are fine immediately they are removed from the toxic environment.

I have to say, Margaret Keenan at the Royal London has been brilliant - she's explained things in detail along the way, listens to everything I have to say and consults me on what I want or would like to happen. She has said that I can pass on her details, if that would help anyone, so here they are: Maternal/Foetal Assess Unit 02073777720, [email protected].

I'm concerned that so little is known about OC, not just amongst the public, but also by midwives and GPs, so I'm going to ask MN if they would run a special feature on it, and maybe get Margaret to do a webchat. Surely we are all proof that by careful monitoring, a potentially dangerous situation can be managed effectively so that both mother and babies are safe!

I hope everyone is managing to get some itch-free sleep, and is feeling well looked-after.

Hey KiwiKat. Maybe contact Jenny Chambers of OC Support and the Imperial Research Team if you want to do some awareness-raising work?

OC Support have been really useful to me, both with the info they have on the website (basic but what I needed at first) and with answering questions on the forum there. If it wasn't for them I may not have known to really push for BA tests.

Jenny has just sent me through 2 really good research papers - one written by docs at Imperial summing up current knowledge of OC and the other about a major Swedish study into OC. One issue I hadn't realised about meconium in the waters is that it can actually penetrate the placenta and umbilical cord and prevent proper blood flow - so it's not just by choking that meconium in the waters causes asphixyation. And if your BA levels go above 20, you're more likely to have meconium in your waters.

Baby was delivered safely at 37 weeks on 5th November. How is everyone else doing?

Congrats Kiwi.

I have just found this thread. I am 28 weeks and this week I am itching like mad. Arms and legs and now my hands. Although it seems to have come out in a little rash as I am scratching so much so I am hoping that means it isn't OC.

I have the MW on Monday anyway so I am going to mention it. Glad I found on here that I may need to push for the tests. If MW isn't willing then I will just see my GP who is great anyway.

Hoping it isn't as after my last forceps and 3rd degree tear birth I was hoping for something a bit less interventional this time. Have a choice about having a c section which I wasn't going to but if I do have OC then I don't want to be induced and will probably opt for a c section instead.

Good luck, Crazy - even if you don't tesr positive for OC, make sure they continue testing for it, as it can take a while to show up in test results.

Will do. Had another awful night where it kept me awake. Got a feeling its a sign that it isn't going away anytime soon, whatever it is.

Is there any cream that will help to soothe skin at night? Being colder helps but its too cold not to cover up.

A lot of people suggest trying Dermacool cream (aqueous cream with 1% menthol) but I actually found a Vaseline Lotion with Aloe & Cucumber that helps me more. It doesn't help much though - no cream does a huge amount for OC itching.

Really try not to scratch as it will only make it worse - it increases sweat and blood flow to the area which is not what you need when those fluids are carrying bile acid and hormone metabolites that are making you itch!

Creaming my feet/legs and then wearing thin cotton socks at night has helped me. I did also consider trying to find thin cotton gloves as well! Scratch mitts for adults, lol.

Congrats KiwiKat !

I'm seeing the antenatal clinic docs and having a scan tomorrow and am 37 weeks on Wednesday, so we'll see if/when things will be happening for us. I'm really hoping I go into labour naturally before 40 weeks (they've said I won't be going over even if my levels mean early induction isn't a good option). Still itching at night though and so uncomfortable with that and everything else I'm hardly getting any sleep, so although I'll be sad to not be pregnant anymore, I'll be glad to get things moving and get baby safely out!

Tests came back clear. MW took it seriously, she was fantastic and sent me straight up the hospital, just to make sure. It seems it is an allergic reaction as I have a rash and I was itching when the doctor was with me and the fact that my skin came up in little bumps (like if you were stung by nettles) told him that it was a reaction.

Hi,
I have even reading this post with interest although I know it is now a few years old.
I am pregnant with my second baby. First baby diagnosed with oc very late after 5/6 weeks itching intensely because I did have a rash and my hands and feet were not affected.

I've begun itching with this one over the past 8 days or so and already prescribed piriton and menthol cream. It's not as severe as last time (yet, pehaps) however it is the right type of itch.

So far bloods are normal. Bile acids of 5.

I was wondering if anyone who posted on this thread is still around?

Hi

Well the itching has increased and now my hands and feet are involved. Mainly my hands start burning.

Bile acids from this Tuesday were 8 so on the increase but bit high enough for diagnosis. I suppose next week they could be or at least if they increase again I will feel more certain it is oc coming. It's torture itching like this and not having a solid reason.

It certainly feels like that same crawling itch. I'm finding if I stay cool, wear loose clothes, regular baths and cream and use piriton at night I'm coping to some level but still have he more severe bouts of itching and the burning hands are so sore.

If my bile acids come down next week I will have to accept it's maybe not oc and I will have to cope with the itch.
I've asked to set up a consultant appointment regardless if the next results since it's getting worse.
They aren't yet aware of my itching. It's just my community midwife.

I'm wondering if given my history and if he bile acids are rising they may take pity and give me a low dose or urso to see if it helps? I know with my son the itch started mildly and got gradually unbearable so it would be good to get some help ASAP.