Obstetric cholestasis

This is a good overview of the condition. Remember – it is a diagnosis of exclusion.


  • Pruritus without a rash (except excoriation). It is often worse at night and affects palms and soles too.
  • Cholestatic symptoms (pale stool / dark urine / jaundice)
  • Deranged LFT (transaminases / gamma-GT – bilirubin and bile acids may also be raised). Beware; LFT can take weeks to rise, so if the woman has persistent pruritus, measure LFT every 1 to 2 weeks.


  • To exclude other causes of liver disease – Hep ABC screening, EBV, CMV, Liver autoimmune screen, Coagulation screen


  • Refer to obstetrics (need weekly LFT / regular BP and dipstix to check for pre- eclampsia, which is a differential diagnosis)
  • Emollients / Chlorphenamine
  • Other drugs are secondary care (eg ursodeoxycholic acid / dexamethasone)
  • Post-delivery follow-up in secondary care – women need to be advised of the following:
    • Higher risk in subsequent pregnancy
    • Higher risk to family members
    • Need to avoid oestrogen containing contraceptives
    • No long term physical sequelae to baby / mum
    • Recheck LFT (normally at about 6/52).

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