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History of complete placenta praevia, have kell antibodies, severe cholestasis. Suggest?

Hi, I have a history of complete placenta praevia with last baby, delivery at 32wks, 13 yrs ago to live and thankfully healthy daughter. I am now 31 +6 weeks, have PP again (already been admitted with bleeds), Kell antibodies (normal levels - titre 4) and have been experiencing preterm labour signs. Fetal fibronectin test was negative last week. i also have severe cholestasis . The latter was diagnosed at 27 weeks with bile acids of 164umol/l. These levels have ranged between 50 - 114 since diagnosis. I am on 300mg Ursodeoycholic Acid (I m 56kg currently) and wondered what levels my bile acids should ideally be kept at with this medication?
Asked On : Wed, 20 Mar 2013
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OBGYN 's  Response
Mar 2013
thank you for your query.
You are definitely having a high risk pregnancy.
AMongst these, the cholestasis is associated with high risk of intra uterine fetal death.
On ursodeoxycholic acid, the bile acids should be ideally less than 54 Umol/litre.
However, it is not mathematics, and it is rarely possible that with medications you would achieve these perfect near normal levels.
However, continue to take the medicines religiously, and be in close surveillance and follow up with your obstetrician.
If you feel symptomatically better ( no itching , no complaint of diminished fetal movements ), then you are doing reasonably well.
Avoid hepatotoxic drugs and take good liver supportives.
Have very vigilant fetal monitoring in form of daily fetal movement kick chart, regular sonograms and colour doppler studies.
take care
Answered: Tue, 26 Mar 2013
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