Obstetric Cholestasis
Obstetric Cholestasis (OC) or Intraheptic Cholestasis of pregnancy is a disorder that is unique to pregnancy (Kelly and Nelson-Piercy, 2000).OC classically presents in the third trimester (Royal College of Obstetricians and Gynaecologists [RCOG], 2006), With maternal pruritus and raised bile acids (Geenes and Williamson, 2009).It is one of the few disorders of pregnancy that can affect both maternal well being and fetal outcome. OC usually resolves forty eight hours after delivery (Mays, 2010).
This essay will examine the functions of the liver and discuss the role of bile acids in OC. The pathophysiology of OC will be explored. The role of the midwife within a multidisciplinary team, alongside the physical care that is offered to women suffering from OC will be discussed. Finally the use of fetal surveillance to predict and prevent fetal demise will be evaluated. A case study will be referred to throughout this essay (see appendix 1) and in strict adherence to the Nursing and Midwifery Council (NMC) 2008 guidelines on patient confidentiality, the woman shall be known as Jacinta, a Gravida 2 Para 1 who presented with OC at 24/40 weeks gestation and was delivered by caesarean section at 37/40 weeks.
The structures of the body involved with OC are the liver and the gallbladder. Bothamley and Boyle, (2009) describe the liver as the most important metabolic organ. The liver is responsible for the metabolism of carbohydrates, fats .lipids and proteins, previously absorbed in the digestive tract (British Liver Trust 2006).Protein metabolism involves the breakdown of cells to form uric acid which is excreted in urine (Wylie and Bryce, 2008). The liver synthesisizes plasma proteins, and most of the blood clotting factors occurs within the liver. The liver detoxifies drugs and other noxious substances, and is involved with the secretion of bile.
Bile is a thick alkaline substance composed of water, mineral salts, mucus, bilirubin, bile salts, electrolytes and
This essay will examine the functions of the liver and discuss the role of bile acids in OC. The pathophysiology of OC will be explored. The role of the midwife within a multidisciplinary team, alongside the physical care that is offered to women suffering from OC will be discussed. Finally the use of fetal surveillance to predict and prevent fetal demise will be evaluated. A case study will be referred to throughout this essay (see appendix 1) and in strict adherence to the Nursing and Midwifery Council (NMC) 2008 guidelines on patient confidentiality, the woman shall be known as Jacinta, a Gravida 2 Para 1 who presented with OC at 24/40 weeks gestation and was delivered by caesarean section at 37/40 weeks.
The structures of the body involved with OC are the liver and the gallbladder. Bothamley and Boyle, (2009) describe the liver as the most important metabolic organ. The liver is responsible for the metabolism of carbohydrates, fats .lipids and proteins, previously absorbed in the digestive tract (British Liver Trust 2006).Protein metabolism involves the breakdown of cells to form uric acid which is excreted in urine (Wylie and Bryce, 2008). The liver synthesisizes plasma proteins, and most of the blood clotting factors occurs within the liver. The liver detoxifies drugs and other noxious substances, and is involved with the secretion of bile.
Bile is a thick alkaline substance composed of water, mineral salts, mucus, bilirubin, bile salts, electrolytes and