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Another case from MalcolmFrom: Malcolm Griffiths (malcolm@mgriff22.demon.co.uk)Mon Jun 30 16:33:31 1997
Anyone who remembers the last case the histology confirmed the suspected left dermoid but the left ovary contained only a serous cystadenoma. ------------------------------------------ New case - ------------------------------------------
-- ------------------------------------------ 1) First pregnancy. 2) 36+ weeks. 3) Presents to her FP at 36 weeks with generalised pruritis. 4) She's read an article in lay ( parenting ) press about obstetric cholestasis. She tells her FP that's what she thinks she's got. 5) FP says no - you've got a rash - it must be a viral infection ! 6) Rash is maculo-papular, worst in groins, then legs, then upper arms, scarcely anything on forearms, nothing on trunk. 7) Liver function tests show raised bilirubin ( >20 ) and raised transaminases. All other routine labs normal. 8) Decide she does have obstetric cholestasis as she thought - therefore given increased fetal risk ( supposedly ) and recently reported observation that fetla demise is not always predicted by CTG, etc ( AJOG article ), to induce her. 9) Three doses of PGE2 later - no real change in cervix, she's pyrexial, and increasingly unwell. 10) What to do next ? 11) Bear in mind it's now Saturday evening and its the NHS in UK ( ~3rd World ).
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