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Maternal Medicine Posters
Biochemical investigation and clinical management of obstetric cholestasis (OC): how useful is bile acid quantification?
  1. T Lang1,
  2. G McKeown2,
  3. A Hunter3
  1. 1University Hospital of North Durham, Durham, United Kingdom
  2. 2Craigavon Area Hospital, Craigavon, United Kingdom
  3. 3Royal Jubilee Maternity Hospital, Belfast, United Kingdom

Abstract

Introduction Alkaline phosphatase activity is used to biochemically assess cholestasis in non -pregnant subjects. However, due to the production of a placental isoform, it is not useful in pregnancy. Measurements of bile acids (TBA) have been shown to be a sensitive marker in the diagnosis of suspected OC cases.

Methods Retrospective audits were performed against the standards of care outlined in the RCOG green top guideline in patients who attended the Royal Jubilee Maternity Hospital (RJMH) during 2005 and 2009. In 2005 requests for TBA were referred to West Midlands. A regional service was introduced in 2009.

Results In 2009, 43 patients were identified with OC compared to 23 in 2005, an increase of 200%. The prevalence is similar to the estimated incidence of 0.6% in the UK.

The sensitivity and specificity of TBA was 54% and 92% respectively. The sensitivity and specificity of ALT was 79% and 74% respectively.

Conclusion Since the introduction of a locally available TBA analytical service and improved awareness of OC following the first audit, there has been an increase in the identification of this cohort attending the RJMH.

TBA and ALT are both useful in the recognition of pregnancy associated liver pathologies. ALT remains a useful test in identifying liver pathology in pregnancy including OC. However TBA in this audit performed better as a rule out test having a specificity of 92%.

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