21/07/2026
A week ago, a 35+4-week pregnant patient presented with severe nocturnal itching, especially over the palms and soles, along with deranged LFTs. Due to limited resources, serum bile acids were unavailable, and a clinical diagnosis of obstetric cholestasis was made. She was discharged with strict fetal movement monitoring advice.
Today, she presented at 36+ weeks in preterm labour. In the absence of CTG facilities, ultrasound revealed a fetal heart rate of 116–120 bpm. After detailed counselling regarding the risks of fetal distress and the limitations of monitoring, an emergency LSCS was performed.
Intraoperatively, two tight loops of cord were found around the baby's neck, with Grade II meconium-stained liquor. Alhamdulillah, the baby was delivered with a good Apgar score. 🤲🏻
This case is a reminder that careful risk assessment on admission is crucial for making timely and precise decisions—especially in resource-limited settings.
