1. Q6 OC
A Primigravida at 34 weeks gestation, with Obstetric Cholestasis is on regular follow up.
Today her labs are as follows- AST- 62 IU/L, ALT 63 IU/l, Bile acids - 27 micromol /L. Prothrombin time is 15 sec( Normal 9.6 to 12.9 sec) . She is on appropriate dose of Ursodeoxycholic acid. What other treatment should be advised?
Where the prothrombin time is prolonged, the use of
water-soluble vitamin K (menadiol sodium phosphate) in doses of 5–10 mg daily is indicated( usual dose is 10 mg daily). Fat soluble Vitamin K ( like the preparation in injection) will be absorbed poorly in Cholestasis.
There is no specific evidence to support or refute this practice, and the data regarding the risk of intrapartum or postpartum haemorrhage are limited.
Where Prothrombin time is normal, there may still be benefit by way of reduction of PPH risk ( 12 % PPH in women who took oral vitamin K versus 45% in women who did not take) .
However the British National Formulary( BNF) , based on 1955 data, recommends against use of Vitamin K in late pregnancy and labor because of risk of haemolytic anaemia, hyperbilirubinaemia and kernicterus in the newborn- This data likely needs revision, and many hospitals do not follow this advice by the BNF.
Postnatal vitamin K must be offered to the babies in the usual way.
