could my itching be obstetric cholestasis

[motherpeculiar]

I'm almost 36 wks pg and I've been itching now for almost two weeks. I've tried antihistamines (on GPs advice) to no avail. I am smothered in calamine lotion but it's not helping much. I feel miserable and fed up. The itching is constant but wosre at night. My sleep patterns are severely disrupted and I am permanently tired. The itching is mostly on my legs, arms and back, although I experience it a little on my belly.

Midwife and GP both told me it was nothing to worry about (mw without even seeing me but over the phone). GP laughingly said "maybe you are allergic to the baby"

When I went to see a homeopath about it a week or more ago she didn't want to treat me in case it might be obstetric cholestasis but the mw and GP haven't taken this idea seriously.

I've just done some research on the condition and am now very nervous as I read it can cause stillbirth. I don't know what to do.

Has anyone any experience of this or advice?

I do have a rash, which I think isn't a symptom of this condition, although am not sure whether it has been caused by all the scratching I've been doing or vice versa.

Any help much appreciated.

MP

ask for blood tests. they shouldnt be dismissing your fears.

phoned mw this morning and I'm off to the maternal assessment unit at King's this morning to get it checked out

wish me luck!

Lots and lots of experience - what do you want to know? Hope you got well treated this am.

Search my name and OC for all my previous witterings on this subject - thay are copious.

They should have done both LFT's and Bile Acid tests on you this am.

FWIW, a raised, hive like rash (which is what I think you said you had)is not a symptom. YOu can develop a red, scaly dry skin type rash becasue of the itching though.

From what I read (What to Expect when you're Expecting...) itching on the limbs rather than the belly is the diagnostic symptom for OC. See this web page , too.
Sorry....

spent the day at the Materal Assessment Unit where they did the LFT and bile acid tests as you suggested Prufrock. Said it will be two weeks or more until the bile acid test results are back .

The LFT result looks normal although I note (checking it against the Itchymoms website) that they don't actually seem to have tested for Alanine Transaminase (ALT) - just for Alkaline Phosphatase and Apartate Tramsaminase, both of which are within the normal range. Itchymoms (or was it you Prufrock - I've gone through most of your threads now - gosh - you've been through it!) say that ALT is actually the best indicator in the LFT.

I was also seen by a dermatologist who couldn't really say what he thought the red raised areas were. He wrote in my notes that "there are discreted papules with scales over the lower back and extensar aspects. They are psoriat(? - can't read rest of that word) but the itch is not of keeping with this but may represent a degree of cholestasis". He prescribed Diprosalic cream and Diprobase. He also wrote that the distribution is wrong for PUPPP.

The rash is a red scaly dry skin like one as you say Prufrock, and is where I have scratched the most, in these scaly little patches.

They want me to go back next week to have the LFT run again.

I am 36 weeks tomorrow. The risk of stillbirth increases from 37 weeks if it is OC right? If I have to wait 2 weeks for the definitive test then I am putting the baby at risk for at least a week.

oh sh*t. What should I do?

Hi.. I had OC in my last pregnancy... I itched like a looney from about 26 weeks.. mostly on the soles of my feet and palms.. but it would get worse at night and work its way up my legs. Id scratch till Id bleed some nights. I totally sypathise with you. It took weeks before my Midwife took me seriously. My doctor was more concerned (apparently its becoming more common, perhaps MW's see it to often and worse cases to they become a bit lax? who knows) anyway. A normal Bile acid result is around 8... once it gets about 12/13 they treat it as OC. Mine was 8 for weeks and slowly went up every week till it got to 12 and they started to treat me. (nothing will stop the itching unfortunalty)

It doesnt take 2 weeks to get the results. Normally the next day. I was going to the hospital in the end and getting results a day or two later. they treat you with some drug called Urso (longer name.. cant remember the rest) doesnt take the itching away, it reduces your bile acids and the risk to the baby.
If I was you Id demand to see a consultant. Like youve read.. if OC if present then they will try to induce you from 37 weeks. Dont stand for the crap about it takes 2 weeks for results.

Once I was diagnosed I was monitored every week.. I got excellent care!

God forbid, but if your results came back high and they left you for 2 weeks undetected id bloody sue them! Its your baby.. kick up a fuss! The only cure for OC is to have your baby.. My itching stopped the same day i had my son.

Im 27 weeks pregnany and itching again.. ugh! They take it much more seriously second time round thank god.

The worst that can happen is that nothing is wrong with you and you itch till you have your baby.

Good luck with the itching.

I think this is perfectly normal-sorry I had it with my son from 26 weeks onwards, was also scared but as m/w said other condition is normally on soles of feet or limbs.

I tried everything, nothing worked, just sleep in cotton nightwear, wear least as poss-its worse at night because you are hotter. When it got really bad, i would strip off in the bathroom and lay tepid cool/cold wet flannels on my belly until it cooled down and soothed it

good luck and i hope it passes soon/gets more bearable xx

Hi i had oc and preaclampcia with my boy was induced after 37 weeks i went to hospital on thurs and was told to come back again tues( im keeping this short obviously i had been suffering for a while by then) i cried in pain when i had a shower on sat.for the itching and odema on my legs and my husband took me to hospital and they kept me in and induced me the next day. A health visitor told me afterwards that this has only been a recognised condition for a few years and the stillbirth rate has halved since then. Go back and stand your ground say youre so anxious about it that youre worried youre distressing the baby. Its lucky they kept me in as my husband said he would have made them by refusing to take me home. btw take loads of calamine into hospital they gave me a eggcup full to do my whole body and be warned it doesnt always stop the minute baby is born it may take a few weeks. Good luck and my sympathies its horrid. xx

thanks guys

I didn't realise this itching in pregnancy was so common. Like you Louismama I have cried in the shower from the pain of the water hitting my back and legs.

Hopefully it isn't OC but if it is I really need to know now. I'll call the unit I was at yesterday and see if they can hurry up the results. Think I'll tell them that otherwise I'll insist on being induced at 37 weeks just to minimise the risk - that might hurry them along!

They were so blase yesterday, saying it would be two weeks or more. I guess they are not REALLY worried that this is OC, but if there is any chance at all surely they should be. I most certainly am.

Seeing my community midwife tomorrow so I'll talk to her about it - but they all seem to have such differing ideas on this (among many other things) that with something this potentially serious I think I need to make up my own mind and just go for it. Ridiculous though that seems as I am not a healthcare professional.

Don't know what I'd do without MN.

Right. Where to start.

catoe - not sure what tests you were having but they weren't bile acids if you got results back within a day - it takes 48 hours minimum to process the blood for them, and there is only one centre in Birmingham that does them. 2 weeks is a bit long though mp- they should be able to get results within 7 days easily - if they phone up and chase.

If I was you I would call the unit now and say that you really are not happy with the care. IMO (and I'm not a medical professional, but was treated by 2 of the best) you should have had a scan yesterday (at least a doppler and preferably a scan of the blood flow through the babies heart - which I can never remember the name of). And it wouldn' hurt to get prescribed Urso just in case.
If they don't listen to you (take some of the info I've linked to before to make them realise you know what you are talking about) you have two options. I'm presuming you are fairly central Londonish, so if you could get to the Royal London (whitechapel tube) and see Margaret in the MFAU she will take you seriously. BUt changing hospitals at thisstage maynot be teh best thing for you.
Alternatively, you could lie, and tell teh midwives taht you've noticed a decrease in movements recently. That should get them to take you seriously - but may also result in them admitting you. And whilst most consultants and hospitals will automatically admit OC cases post 36 weeks, my wonderful consultant really didn't think it necessary - all they can do in hospital is monitor you - but monitoring only tells you that tehb baby is fine whilst being monitored - it has no predictive capacity, so you may as well have tests every other day/weekly scans as an outpatient

Thanks Prufrock

they did do a scan yesterday - forgot to mention that - they checked baby was on target growthwise which it is. Is there anything else they should have been checking? you mention bloodflow through the heart - they looked at the heart but didn't really say anything. One thing they noticed that they thought a little weird was teh baby's bowel, which had liquid in it but didn't seem to be moving much. They called in a dr who said it was fine, just a bowel loop which apparantly is fairly common at this stage. Should this be cause for concern d'u think?

I will start chasing on the bile acid results. Will discuss plan with mw tomorrow and see what she thinks. The mws at my community practice seem to have very different takes on this kind of thing - some are so pro-natural and homebirth they'd worry me they wouldn't take it seriously at all. So I'm fully prepared to take myself back to kings if necessary.

I am still hoping it is not OC. Waiting to see if the Diprosalic stuff they gave me yesterday helps at all. My itching is intense, but doesn't sound AS excruciating as some of the tales I've read so maybe it'll all turn out to be a false alarm. Fingers crossed.

Thanks again for the advice Prufrock.

Never heard of a bowel loop - but if they've noticed and dismissed it I wouldn't be too worried.
It's unlikely that they would have done the herat scan unless you had a specialist in - most sonographers aren't qualified (I think it's fairly newish as I wasn't given one in my first pregnancy). But they will probably have done a doppler of the umbilical artery (you may have heard a swooshing sound if they had the speakers on?) This measures the flow of blood between you and the baby. One of the possible causes of problems is sluggish blood flow. If you check the notes from the scan it should say something about enddiastolic flow? If this is good then it is a good sign even if you do have OC.

(Oh and in checking my notes I found the name of the heart scan . It's a Ductous Venosus)

I would guess that the word you can't read is psoriatic.

I had PUPPP. It doesn't sound to me like you have that. The rash is typically on the bump, thighs and around the wrists. It's urticarial, which looks a bit like nettle rash or some insect bites, IYSWIM. A whitish centre with a red wheal surrounding it. My spots merged into one big red blotch by the end. PUPPP is thought to be caused by an allergy to the baby though!

HTH and that you get some answers soon.

It's very common to get extremely dry skin and develop eczema during praegnancy too and dry, scaly, itchy patches do sound quite eczema-like. But of course you need to follow up the tests asap and rule out OC of there's any chance.
At least it seems your baby is healthy right now. Fingers crossed for you.

so maybe it is "just" eczema then. I've never had it before but my younger sister used to suffer terribly

Here's hoping (for eczema - things must be bad!)

if it is eczema does it clear up quite quickly afterwards? I couldn't imagine trying to breastfeed feeling like this

will try to hurry along my results anyway and I HOPE know one way or the other soon

thanks again everyone for your help and insights

Didn't have time to look for these earlier, but here are some photos of PUPPP (mine wasn't as severe as these cases, but the itching still drove me beserk!). And here is psoriasis , also here . And some links to some photos of eczema .

If it's eczema then I would have thought that you would see a rapid improvement with the diprosalic which contains a strong steroid.

good lord Gingernut - now those piccies REALLY made me itch!

thanks for going to all that trouble - I still don't recognise mine exactly - it's a little bit like of all of them probably, although thankfully not as severe as any of those pictures (those poor people)

Still itchy, and kept waking up with it again last night, but I'm trying to be optimistic and will keep on with the Diprosalic, as you say, if it is eczema that should help quickly. If not

I was monitored for OC as well with 2nd pg
Had to tell the hospital what to test though, bloody numpties
I checked with a name I found on a website when I googled Birmingham Uni I think
She emailed me back telling me what to request to rule out OC
I am fairly sure it was LFT's bile acids and salts, the LFT's they did in my hosp but they marked the salts as urg and they went to somewhere else birmingham or similar results were phoned through in 3 days.
It turned out I was fine, but would anybody believe me?
Def push for frequent testing, I was doing tests 2 x a week plus fetal monitoring the same
Good luck

Wow that link is excellent Gingernut - I had Polymorphic Eruption of pregnancy from 38 weeks until ds was 7 weeks - It drove me completely nutty - and absolutely nothing i did helped - I look forward to studying the article this eve!

Glad to report that despite my fears i didnt have it with dd!!!!!!!!

LittleRedRidingHood - that is really interesting that you didn't have it with your dd. Apparently it is more common in women who are having boys (I was). I only had it for about a week before giving birth but I'd had a severe contact dermatitis before that (an allergy to my pelvic support belt) which was just as itchy and I think may have precipitated the PUPPP (both being immune mediated). I didn't have it with my first pg (also a boy). It started to fade almost as soon as I'd given birth but took a few days to clear completely, after which I found I had some nasty patches of eczema underneath.

I too found there was nothing that helped- tried antihistamines (tablets and cream), calamine and steroid creams. Only E45 itch relief cream soothed it a bit. You must have been going spare if yours went on for 9 weeks.

I had PUPPP during my 1st pregnancy (ds1) which began at about 36w and unfortunately it didn't clear up until he was about 7-8wks old. I looked just like some of the women in those photos!

motherpeculiar if this is what you have (rather than oc) at least be reassured your baby is safe; though it's certainly absolutely miserable to be so itchy with little respite. I did manage to bf; after the birth the symptoms very slowly waned until, as I said, I was fine a few weeks later.
Good luck with all your tests; let us know !

horrible: I have been itching like a maniac too, and the GP sent me for a blood test to check on OC.( about 8 weeks ago - I am now 31 weeks pg). My liver function was given the all clear but she prescribed lots of oilatum bath and creams to ease the itching. Aveeno cream is also good but pricey so ask for some on prescription ( they prescribe it for dd who has eczema).Good luck - it's awful to be so itchy, I can't bear it.

my goodness there are a lot of itchy pregnany women around!

I had the midwife around today and she has made an appointment for me with the consultant at Kings for next Tues to try to hurry along the results. I'll get my LFTs rechecked then too. I find it deeply disturbing how unconcerned some of the medical profession seem to be - I mean I know I may not have OC but FGS if I do it's fairly crucial I find out NOW as the baby is at risk very soon. The mw actually sat there and said "well, I'm sure if they were concerned and it were possible they'd get the results back faster" (i.e. shut up) to which I replied "well I'M concerned and I want to know" of course it was helpful that I could back it up with stats from you helpful people that it IS possible to turn the results around in less than two weeks.

My GP has now signed me off work for my final two weeks so at least I have some hope of making up the sleep I've been losing to the manic itching every night. I'm hoping I will now enter this calm zenlike state and all itching will disappear as though by magic. Hmmm...

Thanks for all the support and commiserations to everyone else going through an itchy spell at the moment

donnie - are they redoing your tests?
Lots of midwives still dismiss any itching that happens before 3rd trimester because the literature says that OC itching only starts then. Take it from me taht that is crap - I itched from about 13 weeks and bloods were normal until LFT's suddenly shot up around 26 weeks, weekly bile acids were well within normal until 34 weeks when they suddenly went from 6 to 62!