Question: What alternatives are there to an oral preparation of Vitamin K in women with obstetric cholestasis?
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Answer: The European Association for the Study of the Liver published guidelines on the Management of cholestatic liver diseases in 2009. They make the following recommendations:
"No specific fetal monitoring can be recommended (III/C2).
UDCA ameliorates pruritus and improves serum liver tests (I/B1), but there are insufficient data concerning protection against fetal complications (II-1/C2).
Vitamin K should be supplemented when prothrombin time is prolonged (III/C2).
Timing of delivery should be discussed on an individual basis.
UDCA can be administered to pregnant women with cholestatic liver diseases during the second or third trimesters, when the patients are symptomatic (I/B1)."
(Evidence level IV)
The RCOG green-top guideline on Obstetric cholestasis was published in 2006, and found no evidence that any specific treatment improves maternal symptoms or neonatal outcomes. This guideline is currently being revised.
A Cochrane review of interventions for treating cholestasis in pregnancy was last updated in 2001, when it found insufficient evidence to recommend guar gum, activated charcoal, SAMe [S-adenosylmethionine] and UDCA alone or in combination in treating women with cholestasis of pregnancy. An updated literature search was undertaken in November 2009, and 19 studies identified, although they have not yet been incorporated into the review. The new studies are listed in the references section of the full review.
References:
- Burrows R, Clavisi O, Burrows E. Interventions for treating cholestasis in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000493. DOI: 10.1002/14651858.CD000493. Abstract and full text (restricted in some countries. Full text for RCOG Fellows, Members and Trainees is available here
- European Association for the Study of the Liver Clinical Practice Guideline. Management of cholestatic liver diseases. Journal of Hepatology 51 (2009) 237–267.
- Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis. green-top guideline 43. 2006
Search date: November 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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