Intrahepatic Cholestasis of Pregnancy — RACP Adult Medicine MCQ

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ModerateGastroenterologyIntrahepatic Cholestasis of PregnancyRACP Adult Medicine

A woman at 32 weeks has intense nocturnal pruritus of palms and soles without rash, serum bile acids 45 micromol/L and mildly raised ALT. Ultrasound shows no obstruction. What is the most likely diagnosis?

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Correct answer: C — Intrahepatic cholestasis of pregnancy

The best answer is “Intrahepatic cholestasis of pregnancy”. Pruritus without a primary rash plus raised bile acids in late pregnancy is characteristic of intrahepatic cholestasis of pregnancy. Pemphigoid has a visible eruption, while acute fatty liver and HELLP usually produce systemic illness, coagulopathy, hypoglycaemia, hypertension or thrombocytopenia. Management requires obstetric review, exclusion of other liver disease, symptom treatment and fetal-risk planning according to bile-acid severity.

Reference: South Australian Perinatal Practice Guideline: Cholestasis in pregnancy: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/womens+and+babies+health/perinatal