Skin and liver function tests

[pie]

I went to my doctor this morning to ask for something stonger for my abdominal pain. (Some of you might remember that 2 weeks I had an ovarian cyst burst and I've been bedridden since). Anyway I mentioned to her that the doctor I saw about 3 weeks ago prescibed some cream for my eczema and that it burnt, so I asked for a different cream. The discoloration and eczema is mainly on my torso but I get itching even where there is no eczema. I have never had it this bad before.

She actually looked at my sking and pointing to some areas of grey/yellow skin in the middle of my red irritated skin asked if these were there before. I said no, so shes ordered liver function tests.

Now I'm terrified!!! I heard about excessive itching when I was pregnant with DD and have heard of Cholestasis. The surgery can't take blood till next Wednesday due to the long weekend.

If it were something like that (and I know its rare) there is still every chance that this baby will be alright isn't there?????

I'm 14 weeks, had an IUD removed at 8 weeks, been hospitalised with hyperemesis, and hospitalised with my ruptured cyst. And to be honest I don't think I can take many more complications...

Does anyone have a similar experience and been ok??? Can anyone stop me going mad???

[LIZS]

Presumably your gp is not overly concerned if he felt the test could wait that long, or was he not aware of the time scales for appointments if you had to book it separately (in which case could he get it brought forward).

Otherwise could you go directly to the hospital for a blood test. Does your area operate an early pregnancy clinic or could you phone the maternity unit for advice. It does seem ridiculous that you should have to wait a week just to get the blood taken and presumably then await the outcome, after all you have already had enough to worry about.

hope all is well

[tamum]

I can't give you any personal experience, but I've just been looking at some articles on Pubmed, and it sounds as though with proper management, even if it IS cholestasis, there is a very good chance your baby will be fine. There was a paper where 70 women with cholestasis were followed up, some of whom had got it by 21 weeks, and all the babies survived. In another study liver function tests were done on a whole cohort of pregnant women and 3% of them (142 in total) had abnormal LFTs. Only two fetuses were affected out of all 142. I would say the bottom line is try not to worry (fat chance, I guess!), but Lizs is right, it might be worth trying to get the test done as early as you can, for your own peace of mind if nothing else. Hugs to you, you're having a miserable time.

[pie]

Thanks for the replies.

I have my booking appointment this Thursday, if I mention the symtoms, my doctors reaction and the wait for the test do you think that they would take me word for it and throw in liver function with the other tests they do at a booking appointment?

[tamum]

I've no idea how they'll respond, but god yes, go for it and don't be afraid to make a fuss. I would demand to see your consultant (well, ask nicely, at least!). You should definitely try. They're supposed to be caring for you in obstetric terms, and you're worried about your symptoms affecting the baby so they really should look into it. Good luck.

[prufrock]

Pie. Stop going mad. If it is obstetric cholestasis, there is NO danger to the baby at this stage. There is a slightly increased risk of stillbirth later in the pregnancy, which increases significantly (to about 20%) after 37 weeks. This is why women with OC tend to be induced at this stage. The only danger is stillbirth - there are no other complications known.
OC itching tends to be on the extremities of the body, and is not helped by creams or anti-histamines. It does not tend to be accopanied by a rash as it is itching from the inside, not a skin condition. If you have it, the LFT's may show raised transemanine levels. However sometimes they don't. I started itching at 18 weeks, but LFT's were normal. It was only when I insisted on having more done at 32 weeks that they were raised (and then they were 20x normal) If you are still itching on extremities insist on a blood bile acid test. There is only one lab in Birmingham that does this so you may have to fight for it, but it is the definitive test.
If you are diagnosed, they should give you Urso, whcih will help the itching and manage your bile acid levels.

This is purely my own personal theory, but a lot of the people I have heard of with OC also had hyperemsis. As a possible cause of both is high levels of pregnacy hormones, or increased sensitivity to them, there may be a link. There was another recent thread about this here www.mumsnet.com/Talk?topicid=138&threadid=6953&stamp=030402162310

[Marina]

You've had some expert advice there, Pie, hope it and your GP's appointment help put your mind at rest soon. I'd definitely nag for the liver function test to be done with the others at your booking-in - I think we could all be screened for a whole lot more relevant immunities/complaints then. It only seems to happen if you make a fuss, so go right ahead. You're entitled, I think, after everything that's come your way lately. Good luck and let us know how you do.

[pie]

Thanks again for the messages, especially prufrock!

I read through that thread and feel very very very reassured!!!

I'm off to my first antenatal appointment in an hour. I decided I would mention it, but still have the blood test next week as I'm not sure what exactly my doctor has requested. It would seem that at this stage I have quite a few weeks before anything would become urgent, even if there is anything to be urgent about!!!

Thanks again guys.

[Katherine]

Pie, obviously only a test will set your mind at ease and now that the worry is there nothing else can really reassure you. But... if you look at the mums moving on.... thread then you'll see that all 3 of us are moaning about itching at the moment. Mine is worst on my Bum (!) but also on my arms and legs in the evenings and the skin is very dry - looks a bit like ezcema although I've never had skin problems before. I didn't have this with my other pg so it took me by surprise and if so annoying. I have to admit I have had my moments worrying about OC but I know that itching in pg is very common now. And I am sure that if there were problems with your liver then the skin discolouration would be more general and perhaps the whites of your eyes slightly yellowy too. Anyway hope they sort you out but I would invest in some decent mousturiser if I were you.

[windmill]

Hello pie, I know you're feeling less worried now anyway but I'd just thought I'd say that when I became pregnant with ds I suffered terrible itching especially at night. It was mainly on my legs and fingers and it drove my mad. I couldn't use even the gentlest of toiletries and I carried throughout the summer do the heat made it worse.

I do feel sorry for you, I was constantly scratching and when I got up in the morning, my fingers and legs were so sore where I had scratched the skin off.

You've really been through it by the sounds of it. I really think you have just generally very sensitive skin. My ds had very bad excema which started when I started hi on solids and aqueous cream made him worse so I tried chamomile cream and then Diprobase which was really brilliant and cleared it up in no time. Have you found that eating certain foods aggravates the problem.

[prufrock]

windmill - wer you tested for Obstetric cholestasis. The itching on your fingers/legs is a classic (and usually the only) symptom. If you do have another baby it may be worth mentioning to your doctor as it often re-occurs and can be dangerous if not diagnosed and managed. I really don't want to worry you, but it is often missed, and can end a pregnancy if not treated.

[windmill]

Prufrock, I mentioned the itching but my GP and midwife said it was normal and didn't bother investigating it. I wasn't reassured and decided if I got pregnant again I would have an independent midwife as I was really worried.

However, they were right, it can't have been OC because the symptoms started again last June and I still have them now. Maybe its dust mite allergy.