Obstetric Cholestasis Negligence
Obstetric cholestasis is also known as intrahepatic cholestasis of pregnancy. Until most recently, doctors didn’t know much about the disease. It was often misdiagnosed and mismanaged. In reality, the condition can be very dangerous to the fetus and the mother. It is estimated that seven out of every 1,000 pregnant women in the US have this disorder and most doctors believe the condition is often undiagnosed.
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^^ back to the topOur medical negligence solicitors deal with personal injury compensation claims arising from clinical errors relating to obstetric cholestasis. We deal with claims using the no win no fee scheme. To speak to a member of our medical negligence team about obstetric cholestasis just email our offices or complete the contact form or call our helpline. We offer free advice with no further obligation.
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^^ back to the topIntrahepatic cholestasis of pregnancy or ICP is a condition of the liver that affects the flow of bile through the biliary ducts. Bile doesn’t pass through the hepatic duct so that digestion and absorption of fats is interfered with. It can cause severe itching of pregnancy and, if it becomes severe, it can cause actual jaundice. 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. The condition appears to have some genetic component because women who get it have a family history of liver disease or similar problems of pregnancy. The exact cause of the disease, however, is not really known.
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^^ back to the topThe most common symptom of intrahepatic cholestasis of pregnancy is severe itching. It can be so bad that it interferes with sleep and activities of daily living. The most common locations of the itching are the palms of the hands and the soles of the feet. Jaundice is a less common symptom but indicates that the disease is more severe. Jaundice is manifest in 20 percent of women who have ICP. 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.
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^^ back to the topConsequences of ICP are not much of a problem for the woman but there can be significant risks to the fetus, including hemorrhage, fetal distress, stillbirth and premature birth. In fact, 44 percent of women who have ICP will have their baby before 37 weeks gestation.
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^^ back to the topThe 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—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. The biggest problem is that not very many laboratories do this test so if the disease is suspected, it should be treated without the results of the test.
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^^ back to the topHistorically 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.
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^^ back to the topMonitoring 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. If the baby reaches thirty-six weeks gestation and has mature lungs, an early delivery can be planned to get rid of the itching and to deliver a healthy baby. A cesarean section is not necessary after 36 weeks.
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^^ back to the topFortunately, 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.
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