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Obstetric Cholestasis Anaesthesia — FRCA Final MCQ

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ModerateObstetric AnaesthesiaObstetric Cholestasis AnaesthesiaFRCA Final

A 38-year-old woman at 32 weeks gestation presents with severe itching, dark urine, and pale stools. LFTs show: ALT 180 U/L, ALP 450 U/L, and bile acids 68 μmol/L. Bilirubin is mildly elevated. What is the diagnosis and its significance for obstetric anaesthesia?

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Correct answer: C — Viral hepatitis – infection control measures

Intrahepatic cholestasis of pregnancy (ICP/obstetric cholestasis) presents with pruritus and elevated bile acids (>10 μmol/L is diagnostic; >40 μmol/L is severe). The anaesthetic significance is: (1) vitamin K-dependent coagulation factor deficiency from fat malabsorption (check PT/INR before neuraxial block), (2) association with preterm delivery, and (3) potential for fetal compromise. Coagulation should be checked and corrected with IV vitamin K if prolonged. Ursodeoxycholic acid is used for treatment. ICP is associated with increased risk of stillbirth, so early delivery is often planned.

Reference: RCOG – 2022 – GTG 43 Obstetric cholestasis; OAA – 2024 – Quick Reference Handbook