Question of the Week # 207

207)  A 30 year old  pregnant woman with 32 week gestation presents with severe itching that is present through out the day and  interferes with her sleep at night. The itching is more on palms and soles. She had a similar problem during her previous pregnancy. She denies any history of eczema or liver disease in the past. Physical examination reveals excoriations on the skin. There are no papules, wheals or plaques. There is no scleral icterus. Laboratory investigations reveal an elevated Asparate aminotransferase ( AST) 140u/l , Alanine Aminotransferase (ALT) 150u/l, alkaline phosphatase at 280U/L ( Normal 40 to 120U/L) and Total bilirubin 2.2mg%. Complete blood count is with in normal limits. Hepatitis profile is negative. Which of the following is the most common complication associated with this entity:

A) Hepatic Failure

B) Fetal Prematurity

C) Renal Failure

D) Disseminated Intravascular Coagulation

E) Severe Post-Partum Hemorrhage

6 Responses

  1. B: preterm birth/ fetal prematurity or still birth.

  2. intrahepatic cholestatis of pregnancy.
    Ans B.

  3. ICP presents greater risk to the fetus than to the mother. ICP increases the rate of preterm delivery with the associated mortality and morbidity. In addition, the fetus is at an increased risk for stillbirth. The major concern for the mother is for postpartum hemorrhage if her vitamin K level is low, leading to an increase in prothrombin time.

  4. B:)

  5. Answer is B

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