Wednesday, 15 March 2017

Getting Diagnosed with Obstetric Cholistasis

If you have been following my weekly bump updates you will know that I have been having a problem with itching for the last 10 weeks (since I was 13 weeks pregnant) and it has been getting worse over that time. Since my 20 week anomaly scan with for our baby girl I have been having various bloods and liver testing/ scans done to find out why I have been so itchy. Up to this point there was no answer and almost everything was coming back at normal which was both a relief and a frustration as they can't help fix something that isn't showing up!

Well I have now been diagnosed with a rare pregnancy condition called obstetric cholistasis or sometimes refered to as OC for short. Obstetric cholistasis is a condition of the liver. This condition is rare with it affecting around 1 in 140 pregnancies in the UK.

Obstetric cholistasis is a serious condition that usually starts in the third trimester of
pregnancy although in the very rare cases like mine this condition can start much earlier. (this is so rare that my hospital have not had a case as early as mine) The condition itself has a lot to do with bile acids,these help your body digest food. The bile acids in pregnant women who have obstetric cholistasis are not used properly and this causes them to build up in the body and at this point they can be detected in the blood.

Bile acids can be detected in a small amount in everyone's blood since they aid in digestion. Bile acid levels above normal but below 40µmol/L are considered to be a mild case while those above 40µmol/L are considered to be a severe case.

The main symptom of obstetric cholistasis is itching without any rash to explain the itchiness. The itchy feeling is often worse on the hands and feet although it can be an itch all over your body (mine is all over my body). Other symptoms can include dark urine, pale poo and it can also cause jaundice (when the whites of the eyes and skin turn yellow or yellowish).

Obstetric cholistasis has been linked through medical studies to be the cause of premature labour and still birth in some babies whose mothers have the condition. The most recent research into this suggests that the risk of stillbirth for those who have a bile acid level above 40µmol/L is between 1 and 2 in 100. While the risk goes up to between 4 and 5 in 100 in those with a bile acid level of 80µmol/L. The condition can also cause an increased risk that the baby will poo while still in the womb which can cause problems if the baby breathes this in during delivery as it can irritate their little lungs.

Okay, now that I have shared all the information I know from the NHS website and the doctor I spoke to at my maternity unit I will talk about getting diagnosed with obstetric cholistasis.

I am actually going to go way back to when I was 16 weeks +6 days pregnant and in hospital for my perineal infection to be drained through emergency surgery. After I had been taken back to the ward the day of the surgery a few of the nurses asked me about my itching and told me that I would need to get tested. They told me to mention it to my midwife as it can be a sign of a liver problem. After I was discharged and started attending my doctor's surgery to see the nurses there with my dressings another nurse mentioned that my itching could be a sign that something wasn't right with my liver. I wasn't able to get an appointment with a midwife earlier than my 20 week scan which was only about 2 weeks later.

At my scan I did mention it and I was told to go straight down to admissions after the scan and tell them about the itching. I did this and after sitting there for over 2 hours with a rather annoyed partner and a very bored 3-year-old I was told it was most certainly not going to be obstetric cholistasis and it looked like I had a pregnancy rash but that if I phoned back the next day I would be able to get the results of the blood tests they had done. Upon phoning back it did show that my liver function was abnormal and I would be sent on the Monday morning for more in-depth blood tests which would require fasting bloods.

I went to this appointment and had 8 vials of blood taken which got sent off for testing and I was also refered for a liver scan (this was done that same week). I was also told at this appointment that it was very unlikely that it would be obstetric cholistasis as they had never seen a case happen so early but it does happen in the third trimester. That afternoon I got my results from the blood tests and most had come back as normal. It also showed that my liver function result had started to come down which was great news!

At 22 weeks I had a review set with one of the maternity hospital doctors to get the results of those blood tests and my liver scan. Almost everything had come back as being normal with my liver apart from the liver function which was much lower than it had been but it was also still a little high. I was sent to have the fasting blood tests done again on Thursday. On the Thursday morning I went in and had the tests done. If I got a call that afternoon then something had shown up. Later that day I got the call. My liver function and bile acid levels had got really high and after they had spoken to the doctor they had medication I needed to come pick up and take before I went back to the doctor the next morning.

Next morning we set off for our appointment not really knowing what to expect or what was going to happen next and in all honesty I was a bit scared as to what could be wrong. At the appointment the doctor explained my blood results, my liver functions had gone back up and in fact had went over what they had been before which had already been 4 times their normal ranges. My bile acid levels had also gone up and had went from being a level of 4µmol/L to being 111µmol/L (which you will now know is extremely high). She also explained what obstetric cholistasis is. She told me that I have a very early on set of this condition.

At this point in pregnancy we don't want to do anything or to have to do anything as there is no cure for this condition other than giving birth! We are now trying to control my bile acid levels with medication and finding a way to control the itching as best we can. That is all that can be done at this point. For the next 6 weeks I will have weekly fasting blood tests done at the hospital and it will be reviewed at my 29 week midwife appointment. I was also told that I need to keep an eye on how baby is doing and making sure that she keeps moving around. I have been doing this but I am now becoming very aware of her movements and how many times she'll have a moving around session during the day. If anything changes I have been told to go up and see a midwife to be safe.

At the moment we are aiming to get to 36-37 weeks pregnant, so we are aiming to get to that point at the moment and unless baby becomes unhappy and shows signs that she isn't doing well inside we will wait until her lungs are mature. But I won't be getting to 40 weeks with this pregnancy.

As far as how I feel about all of this goes, I don't know. I know I should be terrified but I am not. I am scared, of course I am there are risks to our little girl and she will be coming earlier than we thought. In fact she might be here in 13-14 weeks which is pretty scary in its own right.

At the minute I don't think I am as worried about all of this as the only thing it will really affect now is me and how itchy I am. I think that over the coming weeks I will worry more and more about everything and the potential dangers that come along with this condition. I am worried about how much worse the itching will get over the next few weeks/ months as any information I have found point to it getting worse the further along I get.

I will put any updates on my obstetric cholistasis in my weekly bump updates from this point forward so you can follow along with those too.

Monday, 13 March 2017

22 Weeks Bump Update Baby #2

22 Week Bump - Baby #2

Baby -

This week our baby girl measures around the same size as a spaghetti squash (11 inches) and now weighs about 1 whole pound! She is really getting big in there. 5 weeks ago she was only 5.1 inches! It's crazy to think she will be growing much bigger over the next few weeks and months.

This week our baby girl is developing her senses. She's got taste buds and nerve endings that are advanced enough that she can now experience how it feels to touch and although she is in a sack of water she can feel her mouth, fingers, tummy, legs and even her umbilical cord. It is strange to think she will be able to feel the textures of those areas.


Me - 

On Friday morning we had an appointment at the antenatal clinic with one of the doctors for a review of my blood results and liver scan results. I knew that a lot of them had come back as normal and that my liver function tests had gone down since the general bloods I had done after my 20 week scan. However I did have some cells which are related to the stomach and red/ white blood cell production in my blood which can be a sign of many different conditions and problems so I have now been refereed for further investigation regarding that with the main hospital. I was also given an appointment to repeat the blood tests and if they came back as normal I would not need any further tests regarding my liver. She did then tell me I wouldn't be given any anti-histamines now and that we needed to find the problem and why I was itchy. I wasn't that bothered about the anti histamines at first on Friday however I hadn't thought they gave me any relief. That lasted about 24 hours before the itching got worse and started to get noticeably worse as each day passed. By the time Wednesday night came I was ready to cry with the frustration of feeling itchy! I was now getting itchy under my nails on both my hands and feet. I also started to get cramps in my hands at night from the constant itching. I know I shouldn't scratch when it itches badly but I can't stop it. If I don't scratch it then it will burn and pretty soon my whole body will burn like crazy!

This week our baby girl has become much more active and is moving so much during both the day and night. She does feel quite high up and sometimes I feel her kicking around my ribs (although my womb isn't that high yet). There are times when I think she is unhappy that I am being extra active such as walking more than normal or if I walk faster than my usual pace as she will get herself right down into my pelvis and kick what I am presuming is my cervix. The first time she did that I was really worried she would somehow come out (yep I realise just how crazy that is now! Haha). I know she is getting much stronger in her movements now as I actually seen her make my tummy move when she kicked this week which I hadn't been expecting since I am of a larger size and that would make it harder to see her movements on the outside.

She is very much like D was while I was pregnant and will move happily right up to the moment when anyone else tries to feel her. Simon did attempt to feel her and she was kicking away until her put his hand on my tummy and she suddenly stopped! Hopefully it won't be long before she lets others feel her moving as both D and Simon are patiently waiting at the moment. D asks her very nicely "Can you please, please move for me baby?" which is beyond adorable! He also loves to lie down in bed in the mornings he is off nursery lying over my tummy and sings her some songs. He likes to sing you are my sunshine.

This week I have noticed that I can no longer walk up stairs or steps in the same way I normally would. My bump seems to be in the way. I am starting to think this is just me and that I must walk up the stairs in a strange way! I have to turn my legs slightly to the side or I feel rather uncomfortable and it takes me longer to get up them that way.

As for cravings I do want oranges at the moment again. I haven't really been craving them lately but the other day I just had to have one. I have also been loving Chilli Con Carne recently and I have to add extra chilli powder to mine after I make everyone theirs which is certainly pregnancy related as I am not usually a fan of spice!
Sunday, 5 March 2017

21 Week Bump Update - Baby #2

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This weeks bump shot is a little different from the rest, I took this one myself so it's at a strange angle and much closer too.

Baby - 

Now our little baby girl is measuring up to be about the size of a banana (10.5 inches) and currently weighs about 12.7 ounces. At the moment her digestive system is developing and she is starting to swallow some of her amniotic fluid and the sugars it contains are starting to get absorbed into her body. Her little body is starting to prepare for the time when she arrives and needs to get all those nutrients absorbed herself!

She is still small in there and that means that she currently has plenty of room to squirm around in and enjoy her movements. It won't be too long before she starts to take up more of that space.



Me - This week has been pretty quite for me compared to the last few where I had a lot going on!
I am really enjoying being pregnant, It is an amazing thing that the human body can do and during this week I did realise just how amazing it is that this little human is and has been forming inside me!

She has become much more active this week and sometimes she can catch me off guard if she hasn't moved at all for a while then decides to stretch out quite quickly. I love it! I am still the only one who can feel her movements but I don't think that will be for much longer as she is getting stronger every day.

My body is changing much more rapidly now and I can notice my bump getting slightly bigger when I look at pictures of the last 2-3 weeks. While I was pregnant with D I think I had started to notice those tell-tale signs of stretch marks starting to form although I have not yet reached that point this time round and have yet to notice any stretching of my skin. I am starting to see changes in my breasts  which I noticed over the last week but this is pretty normal for this stage in pregnancy as they are starting to prepare for her arrival.

Over the last week I have gone a little, tiny bit crazy for all things pink! So much so in fact that I now have a good few outfits and some baby grows, vest and other items put away for when she arrives. I have no doubt that by the time she comes I may well have a full wardrobe of clothing to do her for longer than the first few months! It's just so pretty! D is getting pretty excited about all the clothing and actually insisted that we hang up her dresses in his wardrobe. He cleared her a little area one side and every time we buy something to get hung up he has to hang it himself. It is so adorable!

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