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Intrahepatic cholestasis of pregnancy — DRCOG MCQ

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ModerateAntenatal CareIntrahepatic cholestasis of pregnancyDRCOG

A 34-year-old woman at 26 weeks' gestation reports generalised itching, worst on her palms and soles at night. There is no rash and she feels otherwise well. Urinalysis is normal and blood pressure is 112/70 mmHg. What is the most appropriate investigation?

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Correct answer: A — Serum bile acids and liver function tests

Nocturnal pruritus affecting palms and soles without a rash should raise suspicion of intrahepatic cholestasis of pregnancy, so bile acids and LFTs are the key tests. Platelets and urate may be useful in suspected pre-eclampsia but the clinical picture does not point to that diagnosis. The clinical pearl is that a normal-looking skin examination does not exclude obstetric cholestasis.

Reference: RCOG Green-top Guideline No. 43; NICE NG201