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Intrahepatic cholestasis of pregnancy — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Intrahepatic cholestasis of pregnancyUSMLE Step 3

A 30-year-old woman at 33 weeks' gestation has intense pruritus of the palms and soles without rash. ALT is mildly elevated and fasting bile acids are high. Blood pressure is normal. Which of the following is the most likely diagnosis?

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Correct answer: A — Intrahepatic cholestasis of pregnancy

Pruritus of palms and soles with elevated bile acids in late pregnancy is characteristic of intrahepatic cholestasis of pregnancy.

Reference: SMFM Intrahepatic Cholestasis of Pregnancy Consult Series