28 week blood tests - what are they?

[GeorginaA]

It's rather ironic that I'm starting loads of pregnancy threads just at the time I'm actually feeling the healthiest I've felt in ages.

I've been phoned up today to be told that they want to do further blood tests on me after my 28 week blood tests yesterday. I have to go into the hospital this afternoon for them.

I know I had an extra one for potential liver problems due to itchy skin yesterday but have forgotten what the others are supposed to be. Any ideas what might be the issue? What were the other tests for?

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So it's not my liver packing up then?!

Gah, why is the medical profession so efficient at panicking you just at the point when you're feeling really well?!

Had some done last Thursday. Now have a prescription for iron waiting for me at chemist! Seemed to be pretty standard to do at 28 weeks.

Actually I was surprised because I have been expecting to need a glucose test. Had one last pg, gave birth to large baby, and friend with 6 week old had to have one for these reasons (but although she lives across road she was under a different hospital.

Glad to hear you are feeling so well.

Georgina - have you got back the LFT's yet? They will be checking for Obstetric cholestasis, which is a subject v. close to my heart. Are you still itching? Where is it - belly or palms and soles? Did they do a bile acid test?
(Not to panic you, but it can be dangerous if not diagnosed - but once diagnosed it's completely treatable)

They did a bile acid test which I assume might be the one that's come back "low" - maybe these new tests are for the LFTs?

Itchy everywhere to be honest, but then I have sensitive skin and cold weather (which sets me off itchy even when I'm not pregnant!) Hmm... palms and soles aren't affected though. Belly, legs, back, arms, bum...

I've had a nose around at the treatable bit - am a bit concerned in that the medication they give you hasn't been tested properly on pregnant women?! Wouldn't really want any cream for the itching - it's perfectly bearable.

Guess I'll have to wait and see.

It's only not been tested because pregnant women won't submit to proper clinical trials (silly us eh?) It's been used for years with no side effects and for me at least has had a huge effect.
The bile acid test is the best one. A level of under 13 is OK, and they do think that the cause of stillbirths is purely the high levels of bile acids crossing the placenta. In 20% of cases mothers have high bile acids and no change in LFT's (it's the AST and ALT levels they will look at - below 35 and 40 respectively is OK). In a few cases (me included), the rise in bile acids is preceeded by a rise in AST and ALT, but this is not dangerous to the baby.
TBH if the itching is bearable it's probably not OC. And creams or piriton do not work for OC itching (even though every bloody midwife and SHO seems to offer me piriton -I'm getting sick of explaining that it's not a valid treatment option)
Did you notice the colour of the tube? LFT's are normally in red, bile acids in purple.

No, didn't notice the colour of the tube. Thanks prufrock, you've been really reassuring - felt a bit panicky to start with My appointment is in an hour's time, so will be able to grill the midwife appropriately!

I'm desperate to have a home birth and avoid being in hospital (or if all else fails not to have an induction - think I'd prefer a caesarian to that) so I think I'm hyper sensitive to any suggestion that things might not all be well.

After all this panic, I'm probably "just" anaemic or something...

Oh BOLLOCKS.

Yup, it's my liver they're worried about, only it could only be a few dozen other things they're also checking (hepatitis, epstein barr and something else?! Was glazing over at that stage tbh). My bile test was 22 apparently.

Had more bloods today and 15 mins of monitoring.

I need to go in twice a week for monitoring.

Once a week for bloods (HAH, and I wasn't anaemic - they always say I look anaemic and I never am - it becomes a personal victory for me).

Once every other week for scans.

This is going to be fun with a toddler in tow. I get the feeling I'm not going to be having many afternoons "off" while he's at nursery any more

If the levels remain high then inducing me at 38 weeks is looking likely cry

There goes my low-intervention low-medical birth....

Oh and the really fun thing is that it takes me 20 mins to walk to the hospital... (parking there is abysmal and virtually non-existant) ... that's going to be good for my newly discovered SPD, isn't it?!

So much for feeling healthy.

Oh Georgina I'm so sorry - but don't worry - I got through it last time and will do the same again this time, and so will you. I'm afraid it does look as though your low intervention birth is out of the question though.

I've e-mailed you through contact another talker with my number - please call if you want because I know how worrying this can be and I can talk you through all the tests and stuff. Just don't panic. As long as OC is recognized and treated you are OK.

(I'm getting upset on your behalf now because I can remember how devestated I felt this time 2 years ago when I was first diagnosed)

Thank you, you are kind. Haven't received the email yet, but will keep an eye open for it.

Feel a bit tearful at the moment and very disappointed. The really silly thing is, I almost feel resentful of the time involved with all these trips - I've been jealously guarding the afternoons when ds goes to nursery as precious "me" time that I won't get when the baby arrives - I feel that they've been snatched away from me.

I'm upset about probably losing out on the homebirth, too... but because there's still a question mark I can hang on to some false hopes for a little longer - or at least get used to the idea.

I think the whole thing would be a lot easier to deal with if I actually felt ill. As it is, I feel healthier than I have done for ages and almost feel resentful that they're "interfering"!! As the midwife at the hospital said when I mentioned I'd been hoping for a home birth "oh... well you shouldn't have let them take your blood then"!

Hey it could be worse - they could have admitted you!
You may want to argue re the twice weekly CTG monitoring. It's diagnostically useless (only tells you the baby is OK whilst you are on) and has no predictive value. You do get reassurance twice a week, but personally I get that every day from the fact my baby is kicking the hell out of my bladder. The scans are more useful and if they monitor fetal blood flow can have a predictive effect (so they can say that if everything is OK today, it will be for the next week or two), especially if combined with regular bloods. That's not guaranteed though, because they haven't completed the research yet, but my consultant seems very positive about it.

Some of the main research for this is actually happening in Birmingham, so at least you are close - my bile acids take longer to get back because they have to be sent to Birmingham.

Oh and if you do get my e-mail, ask for Mary, not prufrock on the work number!

I may well argue the bi-weekly thing, thanks! I'm going to be collapsed with exhaustion before 38 weeks at this rate!

I'm finding it quite amusing that the NHS thinks I'm too petite to give blood as a donor, but are quite happy to take an armful every week out of me for testing

LOL re: asking for prufrock

um twice weekly not bi-weekly ... I think... oh god my brains melting ... must be a side-effect of the liver

Georgina - park at the countryside centre and walk from there by the woods. That's what I tell dh to do when he takes dd1 for her checkups on her ears. Get in touch if you need a hand with anything.

Thanks Ailsa

Out of interest (yes, I know I'm paranoid - but I have been living in London) - is the route via the woods fairly well populated/highly visible area? How long does it take to walk from there to the hospital? Are there parking charges at the countryside centre?

Does sound like a viable alternative!

Georgina, Free parking, it takes about 10 minutes at a fairly slow pace. The footpath is along the outside edge of the woods, there are usually some people about, not masses. The footpath eventually goes to the right, around the staff car park. Instead of going round there carry on straight up along the bridleway, and you'll come out at the pedestrian crossing near the main entrance. What time of day do you have to go, if it's at lunchtime I can walk up with you if you want.

Thanks Ailsa! Dh scoped it out for me yesterday on the way back from work, and it does look nice and easy (he's drawn me a little map and everything ) It's in the afternoon unfortunately, but I'm pretty confident I know where I'm going now, so I should be fine!

Thanks again.

When is your appointment?
Not sure if you foundthis but it's one of the clearer explanations on the web. I had a long discussion with my consultant yesterday and he said he's been seeing women with OC for 10 years now, and sees about 10 a year, and has never lost a baby yet. It reassured me....
And in case you haven't yet found it, the OC support line 0021 353 0699 is run by a wonderful woman called Jenny Chambers, who lost 2 babies to undiagnosed cholestasis, but now has 2 (or maybe 3) perfectly healthy children, and is realy useful on a practical and emotional level.

Tomorrow at 1.45pm. I'm actually looking forward to it now for the reassurance value.

I woke up about 3 times last night at every twinge, convinced that my liver was completely packing in and that I was going to die - completely stupid and overreacting I know, but it made sense at night!

Then I was reading loads of stuff this morning and I keep reading about the itching being unbearable and on palms and soles of feet and mine isn't unbearable and isn't in those two places (everywhere else, mind). So I'm getting a bit panicked that it's actually something else worse.

Bile acids of 22 - is that "mild" OC or "bad" OC or what?! I don't really have anything to compare it to.

Decided I'm giving myself permission to feel sorry for myself this week, then start thinking positively next week!

It's early days yet - the itching can get worse, and varies between people.
My normal bile acids are 7, anything over 13/14 is a problem, but they can go up to 250. So 22 is mildish - and if you start the urso there is a strong chance they will go down.
Your liver is not going to fail, it's just decided to stop producing one particular substance for a short while - and this is not a life threatening illness.
Think logically for a moment. You've presumably never had any liver problems before. So if you start getting problems at the point in pregnancy when OC normally starts, what do you honestly think the chances are that it is not OC?
You said before you get itchy sensitive skin whe it's cold - do you think there has been any previous correlation between your itching and your monthly cycle? there is a theory that at the times in your cycle when oestrogen levels are high this can cause mild cholestasis. There's also a genetic link, probably on the maternal side - did your mother itch at all, or, further back, did any of your maternal realtives suffer stillbirths? (We found out my grandma had had at least 4 - and back then nobody recognised this)

I can't stress enough that properly managed OC isn't that bad - and I've got a beautiful little girl to prove it. But it is going to be stressful - yesterday was horrid for me as LFT's from last week were up again, but my wonderful midwife called last night with yesterdays results and they were back down.
And if you accept the twice weekly CTG's, you at least get to listen to your babies heartbeat lots, and might even get to hear hiccups. And you'll have and extra 5-6 scans, so you get to see loas of teh baby before it arrives.

Well that's why I started worrying if it was a more serious liver condition - I've always had itchy skin of varying degrees (and spent a small fortune trying different fabric conditioners etc trying to minimize it). Asthma, exczema and hayfever all run in the family so I'd always assumed it was just mild exczema getting worse as I got older. Maybe it does correlate to menstrual cycle - I've never really thought about it before!

Thank you for your reassurances that my liver is not just going to pack in - I knew it was a silly fear, but the middle of the night when you're stressed and hormonal anyway isn't the best time for rationality. The reassurance is very good all the same!

I'm slowly getting used to the idea that it's going to be much more managed, and I suppose that it's good that this new area picked up on the condition (whereas in Croydon with my previous pregnancy it was not - in fact I was told itching in pregnancy was perfectly normal several times by both the GP and various midwives).

Of course having the baby early is going to mean that the birthday is even closer to ds' birthday - this could get expensive in years to come This is soooo going to be the last baby... I'm crap at stress!!

Oh me too (the last baby bit)

You definately have cholestasis - that's proved by the high bile acids and will cause the itching (and possibly dark urine/slight jaundice). But cholestasis isn't a disease, it's a symptom, and simply describes a condition where you have lower levels of bile circulating in your blood - hence the higher levels of bile acids, and a possible problem absorbing fat soluble vitamins (k in particular).
This can be extra-hepatic - where the liver still produces bile but it doesn't circulate properly. That's why they should do a scan to check for blockages in the gall bladder or bile duct. Or it could be intra-hepatic, where you aren't actually producing bile in the liver. Epstein-Barr, cyclomeglovirus, hepatitis, some drug abuse can all be causes of this, which is why they've done the extra blood tests. If none of these come up postive then they'll say its Obstetric cholestasis (also known as intra-hepatic cholestasis of pregnancy if you are still googling) which is just where for reasons unknown at the moment your liver doesn't want to work throughout your pregnancy (I know how it feels). Latest thinking is that it's a reaction to the raised oestrogen. So in a way - I think I said this before - it's the best possible diagnosis - my bile acids and LFT's were back to normal within 2 weeks of giving birth.
Good luck - and whatever you do, don't accept the bloody piriton - it won't help!

And drinking lots of water can help - your body can't process fatty acids, so as well as taking drugs to help it do so, you can drink lots to help flush them out, and limit the amounts you take in. I'm not entirely sure how to limit them, but I have been trying to eat a low fat, high carb, low toxin diet - I figure it can't hurt. My homepath also recommended hot water and lemon juice to help my liver

Hope all goes well tomorrow Georgina.