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Cholestasis of pregnancy — MCCQE Part 1 MCQ

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ModeratePregnancyCholestasis of pregnancyMCCQE Part 1

32-year-old woman at 33 weeks' gestation presents with intense pruritus of palms and soles. There is no rash and bile acids are elevated. Which of the following is the most appropriate next step?

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

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Correct answer: C — Diagnose intrahepatic cholestasis and arrange obstetric monitoring/treatment and delivery planning

Diagnose intrahepatic cholestasis and arrange obstetric monitoring/treatment and delivery planning is best because pruritus without rash plus raised bile acids indicates cholestasis. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Bile-acid level helps stratify fetal risk.

Reference: SOGC cholestasis guidance