Calling Prufrock or other Obstetric Cholestasis experts!

[pregnabrain]

Hello

Wanted to ask your advice.

I had OC with my first pregnancy. Came on with wild itching at 28 weeks. Blood tests and bile acids came back abnormal.

Am now 32+4 with my second and have had mild itching / prickliness for a few weeks. Nothing remotely as bad as last time.

Went for a blood test last week and it came back completely normal. Am over the moon, of course, and put the itching down to paranoia.

But...they didn't do the bile acid test. Just the LFTs.

Do you know if it's poss to have normal liver function but abnormal bile acid results??

A big part of me wants to accept the normal result and attempt to go to term. But not if there's a chance they're just missing the OC by not running the bile acid test.

any thoughts welcome.

ime, it is possible to have it and not have raised lft's.

had it in varying degrees in last 3 pg's.

hoping for hb next time as last bout was very mild.

Hello. Yes, it's definately possible for LFT's not to be raised. In fact it's more normal. I started itching at around 13 weeks in 2nd pregnancy and was convinced it was pyschosomatic - but thought I'd better get it checked out, cue ALT levels in the hundreds. I would insist on bile acids - and have them done weekly - it's the least they sould be doing for someone with a history of the condition. As you are probably aware there is more chance of it re-occuring than not. here are teh clinical guidleines your doctorsshould be following - tbh I'd be concerned that they didn't know what they were doing if they hadn't ordered bile acids on a woman with previosu Oc history presenting with itching.

How is everything else? Dark urine, floating poo? Jaundice?

Hello and thanks. I'll get them to run bile acids next time as well. To be honest, no-one would be doing anything if it wasn't for me asking. Am amazed by this and have discussed with midwives and obstetrician. Their stock answer "well, if you're not itching, there's no point testing you"

And this is a major London hospital.

Everything else fine. Didn't get any jaundice with it last time but really, really dark wee. No sign of that (unless I don't drink enough!). Am a bit pasty looking in the face but that could just be me

I suppose that, as long as I'm not in discomfort, it doesn't really matter whether or not I have it at this stage. it's not like they'd do anything anyway. But i definitely want to know by 35 weeks ish if i'm heading for another induced birth.

liahgen - did they let you go to term with yours then? sounds like you're not anticipating an induction if you're planning HB.

ta both for your help

hiya Pregnabrain, at your name.

No, fisrt time I had it, twas spotted at 40 wks, at exam. Didn't know anything about it then, was a hot summer, just put it down to weather etc. Consultant spotted it, tested that day, bile acids raised. Borderline
retested next day, significantly raised higher, so taken in and induced there and then.

Next pg, I was on lookout, so was tested from 28wks, steroids given , and induced at 38+2.

Next pg, had it borderline again, was being induced at 38+ few days, but madam decided to arrive on her own steam at 17 days early, (9lb 5, good bloody job, I say )

Am hoping that as it was borderline last time, so long as I go in for monitoring, they'll be supportive. Or am hoping baby arrives early like last time.

Hope you keep well, keep us informed.

Wow 9lb 5 and early! I can see why you were glad.

It's funny - I have a feeling this one's going to be early too. It's just so active all the time - feels like it's nearly 'cooked' .

So, how was a second induction then? Easier than the first (please say yes)?

I went to see OC specialists at Queen Charlotte's before falling preg this time and they said that they would consider letting me go to term if LFTs etc not way over normal, but I don't live near enough to be under their care and my hospital's policy is early induction regardless of levels, I think. Sigh.

Congratulations on going for a fourth. Am in awe.

Actually, I have 5, next will be no. 6!!

tbh, 2nd induction was worse than first,had long day of labour, for it all to stop at 11pm, (since 7am) just don't think she was ready, and first one was done at term.

That does not mean yours will be any worse. My dh was not supportive, bad choice of pain relief, epi only partly worked.

I also had polyhydramnious awell for last 2, so just to add bit of interest.

Laughing at myself now, thinking they will support hb next time. They say i am high risk now cos of amount of pg's aswell, and age, (i'm 41)

HOWEVER, I am now a trained Doula, and I know more about what is ok or not, and my rights,

Oh my goodness. Six children - that's amazing!

I think I might push to be allowed to go to term with this one, if my test results aren't too scary. I'm barely itching at all.

I wouldn't be happy to go over 40 weeks though.

Am jealous of you being a doula - i think it must be a wonderful job. If I didn't have an amazing midwife to support me this time, I'd definitely go for a doula.

I'm definitely planning to be a lot more bolshy this time. I was stuck to the bed on continuous monitoring last time from the point they broke my waters. I'm sure this was one of the main reasons why I was in labour for so long - couldn't move to find better positions AT ALL. I'm going to go for intermittent monitoring this time.

I am really looking forward to it, induction or not...

I'm jealous, i'd do it all again tomorrow.

Definately push for the intemittent monitoring. If everything is ok, there is no need to be strapped to the bad, sooo unnatural.
You will keep us informed though won't you?
Know what youmean about not going over though, obviously, we don't want to take risks.

Being a Doula is THE best job in the world, i feel like I have finally found my calling, sounds a bit "heavenly" but that's what it's like. it is such a privalage to be a part of that special time in peoples lives. And to be able to make a difference, it's amazing.

What do you do?

pregna - it's not on the guidelines but my consultant last time (4 years ago now!) was doing some work on predicting problems using doppler and by doing ultrasound on the babies heart and monitoring blood flow through it. His theory was that sluggish blood flow can be an early indicator of problems, but if venous blood flow is strong, and biles/LFT's weren't going up he was happy to wait. In my case it was academic, as I'd had to have an emergency c-section first time, so couldn't have an induced vbac and so had planned an elective. I think if you've already done a vaginal birth there is a far better outcome with induction that for a first time - your body has done it before so knows what to do.

If your doctors are trying to do things you don't accept then you can say no - just wave the RCOG guidelines I linked to at them and make them change their antiquated ways.

Good point Pru,

I was having doppler twice a week, and everything in that dept was really good.
agree much better position to wait in you had natural delivery last time.

Thank you both for your kind advice. It makes such a difference to be able to discuss it with people who know what it's like.

liahgen - i'm a web editor (well, for the next three days until mat leave starts!). So couldn't be further from a doula! I do have a bee in my bonnet about it, though. I know EXACTLY what you mean about being part of a special time in people's lives.

I'll definitely demand blood / bile tests at 35 weeks to know for definite what's going on. Then will make a plan of attack for induction, if that's the way it's going to go.

I'll let you know how it goes. xx