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- All pregnant women should be warned to report
any itching in pregnancy.
- Liver function and bile acids should always
be checked in the presence of itching.
- Liver function need not be abnormal in the
presence of abnormal bile salts and itching for
a diagnosis of cholestasis to be made.
- Persistent itching but normal biochemistry
should prompt repeat testing.
- Ursodeoxycholic acid normalises biochemistry
and helps itching. Randomised controlled trial
data is too small to demonstrate any beneficial
fetal outcome, but it is likely to be beneficial.
- Consideration should be given to administering
vitamin K to the mother in the third trimester.
- Delivery should take place by 37 to 38 weeks,
with careful intrapartum monitoring.
- Maternal symptoms and biochemistry should return
to normal post partum.
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