### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My wife is being diagnosed with Obstetric cholestasis by our gynaecologist in Cape Town. She is 39 weeks pregnant, beginning 40th week tomorrow.My questions are:1. is there any information you may be able to share re longitudinal research on the risks, there is so little research on OC on the web and we are trying to gauge the risk my wife is in (and so much would like a natural non induced birth). Obviously we wont rely on your research or in any way disseminate any info you may send us. 2. my wifes bile results are 19 (norm on our test was stated as 0 - 10) (her S-ALT score is 53 (norm range given as 10 - 32) and her S-AST is 40 (norm range 10 - 32). Is 19 a high risk bile acid level?Any views you may have would be greatly appreciated.Many thanksCharles

### output:

Hi there,Obstetric homeostasis At term (40 weeks) with bile acids of 19 should be induced for delivery. There is no point waiting for labor to start, as every day more is an added risk for further rise in bile acid levels and may affect the baby. The problem of Obstetric homeostasis is it can cause sudden death in a full term baby as the bile salt can cause problem with the heart rhythm of the baby. And at 40 weeks the baby is fit to survive, so delivery should be induced immediately. The risk though less than 1 in 100 is still very important to make note as the baby is absolutely normal and has reached 40 weeks and to be affected by bile salts at this stage would be tragic.Also, the risk of passing meconium during labor or inter is higher and also is the chance of operative delivery (cesarean or forceps) in women with Obstetric homeostasis.  The risk of bleeding after birth in mother is also slightly higher and kept in mind. Vitamin K oral should be given to mother after 36 weeks. The liver function tests should be repeated 10 days after delivery as it takes that much time to get back to normal.Also, the risk of repeat obstetric homeostasis in next pregnancy is very common up to 90% and should be informed to the doctor early in next pregnancy. Hope this helps. Regards.