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 Best of Five 3.49

 

   

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BOF: 3.49

A 27-year-old Asian female attends the antenatal clinic complaining of intense itching of her skin. This is generalised but the palms and soles of her feet are affected to a greater degree. The pruritus is increased at night. She is in her 34th week of gestation and has had no complications and is otherwise well. On direct questioning she reveals that her mother had similar problems during pregnancy and had been told that this was a normal occurrence.

On examination she looked well and there were no abnormalities clinically.

Investigations showed elevated transaminases but all other investigations were normal.

The registrar in obstetrics who sees this patient rings you up for advice regarding this patient. Your advice would be:

a)      Treat with ursodexoycholic acid and plan to deliver the baby between 36-38 weeks

b)      Admit the patient for MRI scanning to localise the site of biliary obstruction

c)      Admit the patient and arrange an ERCP

d)      Deliver the baby by caesarean section immediately to prevent stillbirth

e)      Admit the patient and have her seen by the infectious disease team as the patient probably has viral hepatitis

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