Obstetric Cholestasis - Generalised itching or just hands & feet?

[fettleandminifettle]

Hi All

I know that there have been many threads about before, but I need some reassurance and advice from you lovely ladies.

I had obstetric cholestasis when pg with DD, diagnosed around 32-33 weeks. This time I've been under consultant-led care and although I had very mild itching of my hands and feet around 32 weeks, blood tests showed nothing and the itching went away - I put it down to being more aware of any itching.

Anyway, I'm now 36 weeks and yesterday evening started itching all over, which continued through the night - it does seem to be worse on the back of my hands and heels. When I got it last time, I only remember my palms and soles of my feet (DH seems to remember I itched everywhere and he does seem to have a better memory of my whole last pregnancy experience - i've been blessed with that forgetfulness which means we actually go through this all again!!).

anyway, do you think I ought to ring the labour ward, or try and get an appointment with my consultant for next week - not due to see him until a week Tuesday at the moment. Just don't fancy being admitted on a Sunday, which is what happened last time - mainly because i know have a lovely DD, who starts school on Tuesday and I want to be here for her.

Oh, it's tricky? I hope someone is around for some sensible advice.

Thank you.!
xxx

HI fettle, I think you need to ring them and go in and see them straight away. I had this and had some generalised itching, but mainly on hands and feet.
The fact that you had it before must make you more at risk, and as I understand it, it most often starts in last trimester.
Good luck

I had generalised itching and NO itching on hands and feet (not that I noticed) and still had OC. I would contact midwife for tests to be on the safe side, I think.

Yes, ring l/w. They won't necessarily admit you but they can do your bloods again, monitor baby etc.

If the bloods come back indicative of OC you could talk to them about coming in for regular monitoring and still be around for dd when she starts school?

Thank you - I think I just needed some independent reasoning to tell me I'm not being silly - I hate wasting their time, when I know they are so busy.

I'll give them a ring this morning.

Thanks
x

How did you get on? They monitored me daily but I managed to stay an outpatient until other reasons got me admitted. Let us know the outcome wont you

Hi

They asked me to come to the day assessment unit at lunchtime and monitored baby. All seems well. Took bloods to check LFTs and bile acids and gave me a prescription for piriton - see if that makes any difference.

Going make to monitor baby on Tuesday, then Friday, then next Tuesday - so think they taking me seriously! Should have LFT results pretty quickly, but a little longer for the bile acids. Still hope it is a false alarm.

Thanks for your help - I'll let you know what the outcome of the bloods are!

Thanks for letting us know fettle, hope your blood comes back okay

fettle - I had itching over my whole body with it.

Don't ever feel guilty about going to labour ward etc. Mine told me to come in at any time of day or night and were very kind to me.

Thanks for your continued support - wasn't so itchy today, so felt a bit of fraud, but the itching has started in earnest again this evening! Appointment tomorrow morning, so hopefully know more then! At least if I know for sure, I'll know what I'm working with!

No problem I know it is an anxious time, my ictching was always worse at night, but never severe, but I had quite high readings when they did my bloods

All well with baby - LFTs on upper limit of normal, and bile acids normal, but double what they were when last tested, so on an upward trend. Going back on Friday for another check-up and more bloods to see what they are like then.

Bit strange, as still itching, maybe it is just starting!

xxx

Glad they are keeping an eye on your and the baby. Don't forget to let us know how things are going

fettle - Piriton is unlikely to help. In fact, it won't help, except in a placebo way and possibly as a mild sedative to help you sleep. Chemistry is all wrong -you are not having an allergic reaction but a problem with toxins in the blood.

If LFT's are still on upward trend do ask for Urso - it can (IME) really help with the itching. But there is no need to be admitted with OC - continuous fetal monitoring doesn't actually do any good or have any prevantative effect, so going in for regular bloods is just as effective a form of monitoring

This is a link to the very latest medical advice on OC - your consultant may not have this so it is worth asking if he does anything not recommended in this meta-analysis.

Thanks Prufrock!

I think the only reason I was admitted with DD when I went in for itching was my BP was up a bit that day [couldn't possibly have had anything to do with all the internet reading I'd done about itching in pregnancy before calling the hospital!!] They did give me Urso, as soon as my blood results came back, but no piriton.

This time around they did give me piriton, but I've only been taking it at night to help me sleep! I have to say that the itching has died down now, particularly through the day, it is mild in the evenings and through the night, so I think I might have had a false alarm. Either way they are taking more bloods when I go in tomorrow morning and then I'm seeing my consultant on Tuesday, so see what he says. Feel a bit guilty that I might have cried wolf as the itching isn't anywhere near as bad as it was with DD, but I suppose once you've had OC you are just so much more aware of every itch and it was pretty unbearable over the weekend.

Thanks for your help.

xxx

Hi all

Just thought I'd let you know that the hospital just rang, my AST is 57, so high. Bile acids are only 3, so normal, but they want me back in in the morning for more blood tests and another baby monitor, before discussing what to do with the consultant on Tuesday morning. At least I'm over 37 weeks now - I was induced at 36 weeks DD due to cholestasis, so this is better for baby maturity wise.

I feel a mixture of relief that I wasn't just imagining it and the obvious worry that now comes with actually knowing I have cholestasis again!

Thanks for all your support again.

xxx

I wonder if I have this? I am itching all over and have been for days. Im due this Thurs. My doc has given me Piriton which has done nothing, as expected. I have to have bloods tomorrow. Im hoping I can get the results quickly. No itching on hands or feet but looking at this I guess there doesn't need to be. I am itching everywhere and it is truly unbearable. Hence why im up at this hour!

Edie - call you labour ward/day assessmnt unit today! you need to know as soon as possible

They may want to induce you early if you do have it.
Take care
xxx

I called them at weekend and they told me to bathe in bicarb of soda it's ok, my GP is on top of things, im having bloods done this morning however I had a show and some contractions last night so not sure if ill need induction.

Itching everywhere is more likely to be PUPP - do y0ou have a rash? Hope your Gp helped today.

Fettle, my OC always presented with raised AST and ALT levels first (though higher than yours - my AST peaked at 400+ with 2nd pregnancy) and I wasn't unduly worried- any research that has been done on teh cause of foetal mortality has related it to high bile acids, not liver enzymes.

I so understand about teh relief - I started itching at 13 weeks with ds and I was convinced taht it was psychosomatic, especially when GP told me it couldn't possibly start that early. When my bloods came back with raised liver enzymes I was so relieved I wasn't going mad that I wasn't really worried about the OC - I knew I could cope with that!

Yes it does sound like PUPPP. I have looked it up on the net and seen some photos on a link on here and mine looks exactly like it. Yes I do have a rash, it's everywhere apart from hands feet and face. Tonight my mum came over and smothered me in aqueous and menthol in the hope that I might sleep but here I am again, up on the computer itching like hell.

Anyway, at least the PUPPP is harmless, I mustn't complain!

That is good news (of sorts!) Edie - hope baby comes soon though to relieve you!!! Good Luck.

Thanks Prufrock - I have to as my bile acids are not up, I'm not too concerned about baby. Thank goodness. I've been so lucky that it started so much later this time around - the stress with DD was awful as I didn't really know what was happening and my bile acids and liver enzymes were really high that time. This time, the liver enzymes are obviously higher than normal, but on the scale of things are pretty low really!!

Either way I'm booked to be induced next Tuesday, when I'll be 38+3. Going back for regular monitoring and blood tests until then - if any more increase in liver enzymes they'll induce me sooner. Not really looking forward to being induced, but quite glad I'm not going to be pg for a potential 4 more weeks!! Feel huge and my pelvis is killing me!!

take care
xxxf