Obstetric cholestasis (OC).

Obstetric cholestasis (OC) is the most common liver condition specific to pregnancy and affects around 5,000 women in the UK every year. It's generally benign for the mother although the main presenting symptom of pruritus can sometimes be so severe that the woman scratches herself until she bleeds. However, the main concerns are for the fetus, as the condition is associated with an increased risk of fetal distress, spontaneous premature labour and stillbirth. This article aims to provide information about the condition so that as a practising midwife you can offer women sufficient support should OC be suspected or diagnosed.

Scratching can reveal more than just an itch.

The simplest definition of obstetric cholestasis (OC) is 'sluggish or interrupted bile flow in pregnancy'. In affected women the normal flow of bile out of the liver is reduced and this leads to raised bile salts (also referred to as bile acids) in the blood. This, together with abnormal liver function tests and the symptom of itch, may result in a woman being diagnosed with the condition of OC. Yet OC cannot be classified as one single disease. It is more accurate to think of it as a clinical state where a pregnant woman presents with a specific collection of symptoms and blood results together. This can occur in the context of several disorders, such as hepatitis C infection, adverse drug reaction or acute fatty liver of pregnancy, or can occur as a diagnosis that is only caused by pregnancy. Regardless of the underlying cause, OC is a condition that has the potential threat of stillbirth and myriad variables all of which make it challenging for clinicians to know how to treat and manage it. In this article Jenny and Alice show what these variables are and why there may be a risk of stillbirth.