Obstetric cholestasis — DRCOG MCQ

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ModerateAntenatal CareObstetric cholestasisDRCOG

A 34-year-old woman at 35 weeks has severe itching, normal skin examination and raised serum bile acids. What is the most likely diagnosis?

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Correct answer: C — Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is the best answer because the vignette is testing Obstetric cholestasis and the recommended approach is consistent with RCOG Green-top Guideline 43. The other diagnoses do not explain the combination of timing, examination findings and investigation results as well as the correct diagnosis. Specifically, Ectopic pregnancy; Chlamydia infection; Ovarian cancer; Threatened miscarriage would be suboptimal in this scenario. The key discriminator is the pattern across symptoms, examination and timing, not a single isolated symptom.

Reference: RCOG Green-top Guideline 43