Regarding serum bile acids in pregnancy:
I last looked into this about 6 years ago when training at an institution
with both a bile acid assay and a maternity hospital. We performed the
assay weekly and would occasionally get urgent requests.
Bile acids are a good marker for cholestasis in pregnancy. There is also
some older literature suggsting that cholestasis in pregnancy is associated
with a poorer outcome for the infant and may be an indication for delivery.
>From memory this data was not repeated in newer literature and indications
for delivery are much more related to CTG tracings and imaging studies than
bile acid levels.
My suspicions about the usefulness of this test were supported by the ease
with which clinicians (usually registrars) were put off and who would then
be happy with the test being performed in a few days time, and secondly
that they would be happy for us to analyse last week's sample rather than
collect a new one to get the bile acid status nearer to real time.
In summary, bile acids are probably a good test for cholestasis in
pregnancy but the question of what response the clinician will make to the
result is the important one.
I would be interested in any comments from those currently in this field.
Best wishes,
Graham
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
Victoria St, Darlinghurst, 2010
NSW, Australia
Ph: (02) 9361-2170 Fax (02) 9361-2489
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