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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