Intrahepatic Cholestasis of Pregnancy

Itchy

Step 1: View clinicals

A 27 year old primiparous lady presents at 29 weeks of gestation with generalized pruritus for one week. The pruritus is most prominent on the palms and soles and is worse at night. Her pregnancy has been otherwise uncomplicated. Her medical history is unremarkable for dermatological diseases and allergic conditions. Her full blood count, renal functions and clotting profile are normal. Her urine tests negative for proteins.


Step 2: Order all relevant investigations

Liver function tests

ALT 48 IU/L (normal 0-35) AST 56 IU/L (normal 0-30) ALP 354 IU/L (normal 35-135) GGT: 24 IU/L (normal 0-38) Total bilirubin: 1.8 mg/dL (normal 0.1-1.2) Conjugated bilirubin: 1.2 mg/dL Bile acids: 14 micromol/L (normal <11)

Autoimmune screen

ANA: negative Anti-smooth muscle antibodies: absent Anti-mitochondrial antibodies: absent

Hepatitis Serology

HBsAg: negative IgM anti HBc: negative IgM anti-HCV: negative Hep E antibody: negative

Liver biopsy

There is no evidence of inflammation. Bile plugs in the hepatocytes and canaliculi are noted. The bile ducts are not dilated, and there are no signs of injury.


Step 3: Select appropriate management

Ursodeoxycholic acid
Vitamin K
Emergency delivery
N-acetyl-cysteine


Score: ★★☆