Obstetric cholestasis (OC)

[DeepTraybake]

I went into triage early Tuesday morning as Monday night I couldn't sleep for itching. This included my hands and feet. I'm 37 weeks. Had a blood test done, I've called 5 times for my results but been told doctors are too busy to discuss, but my results have been flagged and need discussing with a senior doctor.

Nearly 48 hours later and still no phonecall, I'm lay in bed tonight unable to sleep because 1. Worrying but 2. Mostly because my feet are itching so bad.

I've just called again, and she said my results aren't too much of a concern just need to discuss the next steps and what we to do moving forward.

Im just not too sure what else to do, there's clearly an issue but I'm getting nowhere and I know how serious Obstetric cholestasis (OC) can be. I wouldn't be so worried if this hospital has been great in the past, but they have missed so many things on my previous blood tests I don't hold much hope.

Just looking for some advice really... And what I can do now.

Thank you

The key result is your bile acids, do you know what this is? I'm a midwife btw.

Please please go back to triage now. You need the blood tests now. I have my reasons for saying this but don’t chase your results up by phone etc, just turn up and say you need to know what your levels are as they can rise quickly and need treatment.

The blood test results now, I mean

chomp did the rules re processing and reporting bile acid levels change over the last few years? I thought they had to be done quickly and results fed back within 24 hrs?

I'd go back to triage in person.

I don't think you need to go to Triage now at this time of night. They won't repeat the bloods if you only had them on Monday. The most they'd do is perhaps prescribe chlorphenamine (piriton) and aqueous or menthol cream, which you also buy over the counter. Obviously you need a plan going forward but it really depends on your results. At our trust we would do oc bloods weekly and the date we offer induction depends upon whether its mild, moderate or severe oc. I know the itching is miserable but try not to worry. If you're happy to post your results I can give you more advice.x

Bile acid results should come back the same day, more quickly if they're processed urgently.

If you have the NHS app you should be able to access your results yourself.

Chomp, that’s what I thought about the time scale for results

Nope, they keep saying they are waiting for doctor to review and call me but apparently been non stop emergencies so not had time yet :( I wish I had my results so I could atleast Google them myself, I can't get them on my app either.

They’re taking too long Traybake. Please don’t wait for them to review and get back to you.

I would try and get some sleep and call them again in the morning, and ask them specifically what your bile acid level is and also your ALT level. At 37 weeks (unless it's severe oc with bile acids over 100) they won't be offering induction yet. I understand you're worried though The RCOG guidelines are quite helpful for more information www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

The guidance around Intrahepatic cholestasis of pregnancy (ICP) has changed massively in the last couple of years. No longer of great concern unless your bile acids go above 100, which is rare. So try not to panic. They used to get very concerned about ICP but research has shown its way less risky than previously thought.
If the Midwife said they're not of huge concern then potentially bile acids are above normal but not too elevated. In that case, you'd usually have them done again in a week.

Now, this is just general guidelines. Obviously not good enough to have your results withheld and no follow up plan in place. If I was getting nowhere personally I'd just go in again. Sounds like you're the only person who will advocate for yourself in this hospital. I would also speak to the patient advocacy contact.

Hello, midwife rang this morning to say they want to re test on Tuesday.. been prescribed anti histamine in the mean time. My results are:
Ferritin - 66
B12 - over 2 000
Folate - 6.6
Haemoglobin - 103
Bile acid - 4
Alt - 71

I’m so glad you’ve got your results back and they’re retesting next week.

You don't have ICP then (it used to be called OC) - the diagnosis level is 19. But it is good they are retesting as sometimes they can go up.

ICP Support is a great charity with the latest information.

I agree ICP is excellent

ICP Support I meant 🫣

Thank you :) !