How is Obstetric Cholestasis Diagnosed?

Diagnosing Obstetric Cholestasis

Pregnancy-specific reference ranges for liver function tests (LFTs) should be used.
Other causes of itching and of liver dysfunction should be excluded.
C - Postnatal resolution of pruritus and LFTs should be confirmed

Treatment of Obstetric Cholestasis

There is no evidence that any specific treatment improves maternal symptoms or neonatal outcomes. All such therapies should be discussed with the individual woman with this in mind.

Topical Emollients

C - Topical emollients are safe but their efficacy is unknown.

S-Adenosyl Methionine

A - There is insufficient evidence to show whether S adenosyl methionine is effective for either control of maternal symptoms or for improving fetal outcome.

Ursodeoxycholic acid

A - There are insufficient data to support the widespread use of ursodeoxycholic acid (UDCA) outside of clinical trials. Women should be aware of the lack of robust data concerning improvement in pruritus, protection against stillbirth, and safety to the fetus or neonate.

Dexamethasone

B - Dexamethasone should not be first-line therapy for obstetric cholestasis, nor should it be used outside of a randomised controlled trial (RCT) without a thorough consultation with the woman.

What is the Role of Vitamin K?

C - It is reasonable to offer a daily supplement of water-soluble vitamin K to all women from diagnosis of obstetric cholestasis. If there is frank steatorrhoea or prolongation of the prothrombin time, the clinical case for the use of vitamin K is stronger.

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Natural Remedies of Gas, Flatulence, and Bloating

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کشف المحجوب

شیخ علی بن عثمان الہجویریؒ اور ان کی کتاب کشف المحجوب پر ایک نظر ڈاکٹر رئیس احمد نعمانی ابتدائیہ علامہ اقبالؒ نے اپنی مثنوی 'اسرار خودی' میں ایک عنوان اس طرح لکھا ہے: ''حکایت نوجوانی از مرو کہ پیش حضرت سید مخدوم ہجویری رحمۃ اللہ علیہ آمدہ ازستم اعوا فریاد کرد'' اس عنوان کے تحت انہیں نے جو کہانی نظم کی ہے، اس کی تمہید میں یہ ابیات بھی لکھے ہیں : سیّد ہجویر مخدوم امم مرقد او پیر سنجر ۱؎ را حرم بندھاری کوھسار آسان گسخت در زمین ھند تخم سجدہ ریخت عہد فاروق از جمالش ۲؎ تازہ شد حق ز حرف اور بلند آوازہ شد پاسبان عترت امّ الکتاب از نگاھش خانۂ باطل خراب خاکِ پنجاب از دم اوزندہ گشت صبح ما از مہر اوتابندہ گشت۳؎ مثنوی کے ان ابیات میں 'مخدوم امم' کہنا اور شیخ ہجویری کے قیام لاہور کے زمانے کو عہد فاروق اعظمؓ کا مماثل قرار دینا، خلافِ واقعہ سہی، تاہم ان پانچ بیتوں میں ، پانچویں صدی ہجری کے معروف بزرگ شیخ علی بن عثمان ہجویریؒ کے بلند روحانی مرتبے، دشوار گزار راہوں سے گزر کر ہندوستان آنے، یہاں آ کر عبادتِ ال

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