Obstetric Cholestasis Compensation Claims

Obstetric cholestasis affects about 1% of women during pregnancy and is a liver disorder caused by a reduced production of bile fluids which causes temporary itching, particularly on the hands and feet, that disappears within a few weeks after delivery. The condition poses a serious risk of harm to the unborn child and unless it is recognised promptly and treated properly can be fatal to the unborn child. It is a phenomenon of the third trimester of pregnancy when the pregnancy hormones are at their peak. In rare cases, it can start in the first trimester and last throughout the pregnancy. Mothers who suffer from this condition will often need to have their baby delivered early to help prevent the possibility of stillbirth and there are usually increases in intensity in subsequent pregnancies. If you think that your condition was worsened or not treated as a result of medical negligence, contact our obstetric cholestasis solicitors for advice at no cost.

High Levels of Oestrogen

The condition can be caused by high levels of oestrogen produced during pregnancy inhibiting bile flow and concentrating bile salts in the blood, resulting in itching and occasionally jaundice, which can result in stillbirth. It is often a hereditary condition and can skip several generations. Any pregnant woman who is itching more than normal should have blood tests for evaluation of liver function.

Symptoms

The itching usually starts on the soles of the feet and the palms, extending to the rest of the body and is usually worst during the night. Mild jaundice affects about 20% of patients and some babies are born jaundiced. Mothers may suffer from malabsorption of vitamins, worsening maternal nutrition and there is about a 20% risk of postpartum haemorrhage which may be caused by inadequate absorption of vitamin K, which is needed for the blood to clot.

Other symptoms include pale stools and dark urine, tiredness, mild depression and loss of appetite. Severe depression is rare but possible, as is pain in the upper right quadrant and nausea or vomiting.

Risks to Fetus

There can be significant risks to the foetus, including haemorrhage, fetal distress, stillbirth and premature birth. In fact, 44 percent of women who have ICP will have their baby before 37 weeks gestation.

Diagnosis and treatment

The best treatment for intrahepatic cholestasis of pregnancy involves diagnosing the disease early. There are medical tests that can be done when ICP is suspected. This includes the serum bile acid test's the most accurate test for the disease. It is a fasting test that measures the bile acid content in the blood. If it is elevated, the condition is almost always due to ICP.

Historically speaking, ICP was treated with cholestyramine, a cholesterol-lowering medication. Recently, however, it has been found to be relatively ineffective in dropping the level of bile acids in the blood. Treatments that have been found to be more effective include Actigall, which replaces bile acids in the blood. It has been shown to reduce the incidence of stillbirth. Vitamin K helps increase the absorption of fat-soluble vitamins and prevents bleeding complications. Steroids can be given before 32 weeks gestation in order to reduce the risk of breathing problems in the preterm infant. Steroids also control itching.

Monitoring during pregnancy is vital to make sure the baby is developing properly. If the baby quits growing or shows signs of distress, an early delivery is proposed. Fortunately, delivery of the infant cures the problem of cholestasis. Even so, the liver enzymes should be evaluated after the delivery until they return to normal. Those women who have had ICP before have a 60-70 percent chance of getting it again.