Obstetric Cholestasis — UKMLA MCQ

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HardObstetrics and GynaecologyObstetric CholestasisUKMLA MRCGP AKT PARA MRCP Part 1

A singleton pregnancy at 35 weeks is complicated by pruritus without a rash and a peak bile-acid concentration of 72 micromol/L. There is no diabetes, pre-eclampsia or other fetal risk factor. Which classification and birth discussion are appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Moderate ICP, with planned birth at 38–39 weeks discussed

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · C = shown as D

B is correct. RCOG classifies a peak bile-acid concentration of 40–99 micromol/L as moderate intrahepatic cholestasis of pregnancy. In an otherwise uncomplicated singleton pregnancy, planned birth at 38–39 weeks may be recommended and should be discussed through shared obstetric decision-making. Severe ICP begins at 100 micromol/L, for which planned birth at 35–36 weeks may be considered because stillbirth risk rises. ICP alone does not mandate caesarean birth. The patient needs obstetric care, repeat blood tests, individualised risk assessment and safety-netting for reduced fetal movements rather than a PA independently selecting delivery mode.

Reference: RCOG: intrahepatic cholestasis of pregnancy: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/ GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map