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ICP in Pregnancy — RACP Adult Medicine MCQ

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ModerateGastroenterologyICP in PregnancyRACP Adult Medicine

A 30-year-old woman at 37 weeks gestation presents with pruritus and jaundice. LFTs: bilirubin 55 μmol/L, ALT 85 U/L, ALP 320 U/L. Bile acids 65 μmol/L (markedly elevated). She has no hypertension or proteinuria. Platelets are normal. What is the most likely diagnosis?

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Correct answer: B — Intrahepatic cholestasis of pregnancy

Pruritus with jaundice in the third trimester, markedly elevated bile acids (>40 μmol/L — severe ICP), cholestatic LFTs, and no features of pre-eclampsia/HELLP is intrahepatic cholestasis of pregnancy. Bile acids >40 confer increased stillbirth risk. Management: UDCA (reduces pruritus and bile acids), plan delivery at 37 weeks for severe ICP (bile acids >40). Continuous CTG monitoring until delivery.

Reference: SOMANZ – 2023 – ICP; RCOG 2024