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Re: Another case from MalcolmFrom: Laifer, Dr. Steven (pslaif@bpthosp.chime.org)Tue Jul 1 11:00:27 1997
<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. Malcom: In patients with intrahepatic cholestasis of pregnancy, it would be very unusual to see such high elevations in the serum bilirubin concentration. How elevated are the transaminases and have other liver injury and liver function tests been performed (GGTP, Prothrombin time). I would be concerned about obstructive jaundice or acute viral hepatitis (and the possibility of fulminant hepatitis and hepatic failure and evaluate/manage the patient accordingly. Best Wishes Steven Laifer MFM Bridgeport, CT
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