Pruritis in pregnancy

Question 1

Workup of pruritis in preg

Answer 1

DDx - PG, PEP, ICP

Targeted HEI
- palm/soles itch, no rash (ICP)
- palm/sole/umbi sparing rash (PEP)
- palm/sole/umbi rash (PG)
- pale stools, DFM
- previous hx of LFT issue/ICP
- FBE/UEC/LFT/BA
- HCV/HBV/CMV/EBV +/- liver USS
- MCS swab if suspect skin infection

Question 2

Mx of ICP

Answer 2

• M risk - itch/coagulopathy
• F risk - mec/PTB/Nursery/SB
• MDI - Obs/Obs Med
• LFT derangement req hepatitic screen
  (HCV/HBV/CMV/EBV +/- Liver USS)
• Sx - antihistamine/emollient/urso
• +/- Vitamin K if coagulopathic
• monitor FM (no role for CTG/USS)
• wkly BA/LFT - >100 (SB risk >bkg risk)
• Aim 37-39, MOD = Obs indication
• PN - no E contraception, recurrence risk, LFT 6/52 + routine…