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Suggest precautions to be taken during pregnancy with idiopathic cholestasis

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6011 Questions

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Posted on Mon, 4 Aug 2014 in Pregnancy
Question: I was diagnosed with idiopathic cholestasis at 33 weeks, LFT levels were high. however repeat test, after taking UDILIV showed decreased LFT Levels. I am now at 36 weeks, what are the precautions I need to take now. Please elaborate on signs that I can monitor for my baby, specially during night (will be difficult to monitor movements all through night). I am noting down 10/12 movements till 9/10:00 PM daily. Please also advice on food, and physical mobility. I am working from home, and have a desk job. I am hoping for normal VD, does less physical mobility increases C-SEC chances?
doctor
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer:
COUNT ONLY DURING THE DAY

Detailed Answer:
Hello
Thanks for writing to us with your health concern.
Is this your first pregnancy ?
Any complications apart from idiopathic cholestasis detected ?
There is no reason to worry if the LFT levels are fine.
Clinically more important, how is the itching, if you have a lot of itching inspite of normal LFT , then that is worrisome.
COntinue taking Udiliv.
Also, keep a very strict vigilance on the baby's movements.
Weekly check up with your doctor is advisable, but with cholestasis, better make it twice a week atleast.
Hope your latest ultrasound scan and Colour Doppler is normal.
Idiopathic cholestasis is linked with the catastrophe of sudden intra uterine fetal death, so be very cautious.
You do not need to count baby's movements at night ( obviously the baby also sleeps !! ).
Just lie on your left lateral side, after each meal ( breakfast, lunch and dinner )
So totally 3 hours , 1 hour after each meal and keep count of fetal movements.
If the total exceeds 10, dont worry and have good night's rest.
Try to sleep at night also in the left lateral position.
Drink lots of water, atleast 5 - 6 litres everyday.
It is better to walk daily and you should have been taught pelvic exercises in your antenatal classes.
As such, there is no link between physical mobility and C section, but increased physical mobility increases chances of relaxation of your pelvic muscles and hence makes you more favourable for vaginal delivery.
Report decreased OR increased frantic baby movements to your doctor immediately.
Go for NST - Non stress test - charting of your baby's heart beat - twice a week.
All the best
Please feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 19 minutes later
Hello Dr. XXXXXXX

Thank you so much for the detailed reply. It really helps and ease out tension out of me.

Following are the responses of your questions, asked above.
Is this your first pregnancy ? - Yes
Any complications apart from idiopathic cholestasis detected ? -No
LFT levels - Are not normal, but lower than previous (SGOT 96, SGPT 186)
Itching: Much relieved
USG, Doppler: Baby height, weight and other things being normal (technician pointed out - umblical cord - wrapped twice around baby's neck)


Concerns:
1. I am worried about still birth - and do not want to take slightest of chance..please help further
2. I try left lateral position during sleep, however this is not constant,as this side becomes numb most of the time
3. I will increase cont. walking by 15 mints - totaling to half an hour
4. Exercises: I afraid I am not aware of any pelvic floor exercises, please help. I heard sitting in cobbler pose for 10 minutes daily is helpful. Or mopping floor, the traditional way also helps.

However, besides all these, my main concern is that baby health remains fine, I should not miss anything of my unawareness/ carelessness

Thanks, XXXXXXX
4.
doctor
Answered by Dr. Aarti Abraham 1 hour later
Brief Answer:
FOLLOW ADVICE, USE BOLSTER, KEEP WALKING

Detailed Answer:
Hello
Thank you for the appreciation.
1. As the itching is less and the LFT is declining, please do not worry. Relax, stress also can harm your child. I have already described the steps of keeping a tab on the baby's movements to you. Just follow the steps in the previous answer and keep calm.
2. I can understand you cannot continuously sleep on one side, just try for majority of the time, Try propping a soft pillow or bolster underneath that side, it will be more comfortable.
3. Yes, please continue walking.
4. Specific pelvic exercises are taught to women right from the first trimester, do not suddenly start doing them, as you would not be used to them. Please go through this, it will help =
http://www.fitpregnancy.com/exercise/prenatal-workouts/ready-set-push
Do not worry, you are a very vigilant and careful lady, and all will be well.
Please feel free to contact me directly anytime at -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 2 minutes later
Thank you Dr. XXXXXXX you have been a great help!

Best, XXXXXXX
doctor
Answered by Dr. Aarti Abraham 1 minute later
Brief Answer:
ALL THE BEST.

Detailed Answer:
Thank you for the appreciation.
You are a most particular and insightful person also.
Please write in whenever you have a doubt.
WIshing you the best of pregnancy and motherhood !

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