OBSTETRIC CHOLESTASIS

Abstract

Obstetric Cholestasis is the commonest liver disease that causes pruritis and is unique to pregnancy. Pruritis can be so intense as to lead insomnia.The Significance of this disease has been highlighted more recently due to the associated perinatal mortality and maternal morbidity. Aetiology and pathophysiology still uncertain. There, appears to be genetic predisposition in certain individuals resulting in an increased susceptibility to the high oestrogen levels found in pregnancy specially in 3 rd trimester and resolving promptly after delivery when oestrogen level falls rapidly. Pruritis is central in origin and thus fails to respond to commonly used antihistamines and lotio calamine locally. Recently ursodeoxycholic acid an exogenous bile acid is increasingly being used and showed improved both pruritis and liver function and favourable changes were observed in the foetus as well. Delivery planned at 37-38 weeks of gestation reduced perinatal mortality. Because of increased rate of adverse intrapartum events, close monitoring is appropriate. Active management of the third stage is necessary because of the increased risk of post partum haemorrhage. Key Words: Pruritis, pregnancy, planned delivery, perinatal mortality and maternal morbidity.