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Old 08-09-2013
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Thumbs Up OB/gyn question #10

A 33 y/o woman at 36 weeks gestation with her 2nd pregnancy comes to the office because of worsening generalized itching that began about 2 weeks ago. The itching is worse at night and especially marked on the palms and soles. She states that she cannot sleep at night and is driving her crazy. SHe has not noticed any rash. SHe has no fever, chills, nausea or vomiting. Her pregnancy has been uncomplicated to this point. Past obstetrical history is significant for a normal spontaneous vaginal delivery 3 years ago. she has no medical or surgical history. she takes a prenatal vitamin daily and has no known drug allergies. Her cervix is closed and the fetus in on vertex presentation. On PE you notice several excoriations.. especially on the palms and soles, but also on the forearms and legs. The most appropriate next step in management is.
A. Check CBC, BMP.
B. Check LFT's and bile acids.
C. Refer the pt to a dermatologist.
D. Reassurance and prescribe dyphenhydramine.
E. Schedule a C-section.
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Old 08-09-2013
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Originally Posted by XpaezX View Post
A 33 y/o woman at 36 weeks gestation with her 2nd pregnancy comes to the office because of worsening generalized itching that began about 2 weeks ago. The itching is worse at night and especially marked on the palms and soles. She states that she cannot sleep at night and is driving her crazy. SHe has not noticed any rash. SHe has no fever, chills, nausea or vomiting. Her pregnancy has been uncomplicated to this point. Past obstetrical history is significant for a normal spontaneous vaginal delivery 3 years ago. she has no medical or surgical history. she takes a prenatal vitamin daily and has no known drug allergies. Her cervix is closed and the fetus in on vertex presentation. On PE you notice several excoriations.. especially on the palms and soles, but also on the forearms and legs. The most appropriate next step in management is.
A. Check CBC, BMP.
B. Check LFT's and bile acids.
C. Refer the pt to a dermatologist.
D. Reassurance and prescribe dyphenhydramine.
E. Schedule a C-section.
B. Check lfts and bile acids
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Old 08-09-2013
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B...intrahepatic cholestasis of pregnancy
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Old 08-10-2013
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The correct answer is B. Intrahepatic cholestasis of pregnancy is an important condition that should be identified ASAP because it has a strong association with stillbirth. ICP develops during pregnancy and is characterized by pruritus often worse at night and on the palms and soles. There are often no other findings on physical examination except excoriations from the patient constant itching. Lab testing often shows abnormal LFT's and elevated bile acids (which are the actual cause of the prutitus secondary to accumulation on the dermis). After the diagnosis is confirmed she should have fetal testing with NST', AFI index and biophysicial profile to see when to exactly deliver the baby.
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