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Dr. Andrew Rynne

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Pregnant. On udiliv. Ultrasound showed deranged liver enzymes. What are the risks?

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Dr. Asra Ishtiaq Ahmed

OBGYN

Practicing since :2008

Answered : 689 Questions

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Posted on Mon, 10 Dec 2012 in Pregnancy
Question: Hello Dr,
I'm 34 weeks pregnant & on udiliv since last four weeks. Yesterday we did LFT again and found the some parameters have increased significantly, is that harmful to baby? Please advice
Also, udiliv (450mg morning and evening) was prescribed by my doctor which I started taking since 30th week of pregnancy & still continuing the same. Please advice.

Thanks,XXXXXXX
doctor
Answered by Dr. Asra Ishtiaq Ahmed 2 hours later
Hello XXXXXXX.

Thanks for writing.

Your report shows deranged liver enzymes. The report and treatment you are taking suggests you have cholestasis of pregnancy.

The risks involved with these LFT levels are premature labor, fetal distress, still birth and sudden intrauterine death.

The only definitive treatment of this condition is DELIVERY.

Treatment with udiliv will only provide symptomatic relief by reducing itching.

So all you can do is to monitor your LFT levels and fetal well being regularly.

You should go for an ultrasound and Non stress test(NST) to know fetal well being.
If these two are normal, you can still continue with your pregnancy at this LFT level.

Serial follow up ultrasound (biophysical scoring) and NST are a must in all cases of cholestasis.
Whenever these tests show that fetus is in distress, it becomes an indication to deliver.

On the other hand, deranged LFT at term (after 37 weeks) even with normal ultrasound and NST, becomes an indication for delivery.

SO for now you go for ultrasound and NST. Discuss your report with your doctor.
You may take antenatal steroids for lung maturation of the baby.

In case your ultrasound and NST are deranged at any time, you have to go for induction of labor and delivery. (artificial pains induced).

If everything is normal, then you just keep a good record of your baby movements along with weekly ultrasound and biweekly NST to ensure all is well with fetus.

You have to keep in mind these possibilities and take your decision according to the follow up tests.

Wishing You All the Best.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Asra Ishtiaq Ahmed 1 hour later
Thanks Dr for your reply.
We had ultrasound yesterday and as per report every things is fine and fetal weight around 2.5kgs also we are in constant touch with our doctor as well. But she have not suggested NST yet but was worried about enzyme levels.

As other doctor is on aboard trip I consulted this platform. Can you suggest if we can wait couple of days before going to NST as doctor will be back from his aboard trip?

Also baby movements are good as of now but sometimes we've observe lots of movements. Should be worry about that as well?

Also if you could suggest what would be ideal time for delivery, can we wait for a week or two?

Thanks,
XXXXXXX
doctor
Answered by Dr. Asra Ishtiaq Ahmed 4 hours later
Hello there.

If your fetal movements are good and last ultrasound was normal then you may wait.

However in case you perceive decreased movements then you should see any doctor at once.

NST is fetal heart rate tracing and helps in knowing if there is any acute cause of fetal distress .
Whereas ultrasound depicts more of long term changes like decreased fluid or weight which are indicators of fetus being unwell for a very long time.

Excess movements are not worrisome provided your last ultrasound was normal.

The ideal time of your delivery would be anywhere after 37 completed weeks when your fetus would be completely mature.

However during this period if you perceive any decreased movemnts with abnormal ultrasound or NST with persistent deranged LFT then you have to consult your doctor for termination.

Risk of still birth and intrauterine death are high with cholestasis even if ultrasound and NST have been normal. Thus it is not considered wise to prolong pregnancy after reaching term.


Wishing you All the best.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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