MMED OBS/GYN.

ESSAY QUESTION

HISTORY:
A 35 yrs old woman is complaining of itching. She is G3P0L0 + 2, currently GA 34 wks . The
itching started 2 wks ago and she had been using emollient cream to try relieve it. Initially it was
mainly over her soles and palms, although it is now more generalized. She is not aware of having
changed her washing powder or soap recently and no one else in her family has been affected.
She has not experienced any abdominal pain although she does not have Braxton Hicks contractions.
There is no vaginal discharge or bleeding. Normal fetal movement.
On examination:
She looks well. Her BP= 110/70mhg, PR= 80bpm. No rash is visible on the face, trunk, limbs, hand or
feet except for a few excoriations marks
FH= 34cm, uterus is soft and non- tender. Cephalic presentation with the level of 5/5
Investigation:
Normal range
HB= 10.3 g/dl 11.5- 15.5g/dl
MCV= 80Fl 74.4- 95.6 Fl
Platelets= 198x10 /L 150-400 x10 /L
Sodium= 132mmol/L 130-140mmol/L
Potassium = 3.3mmol/L 3.3-4.1mmol/L
Urea= 2.9mmol/L 2.4-4.3mmol/L
Creatinine= 68umol/L 34-82 umol/L
Alanine transaminase= 31 IU/L 6-32 IU/L
Alkaline phosphate 120 IU/L 30-300 IU/L
Bilirubin= 8 umol/L 3-14 umol/L
Bile acid= 24 umol/L 0-14 umol/L
Urinalysis= 0-5/HPF

QUESTIONS:
1. What is the diagnosis?
2. How would you further investigate and manage this woman?
3. How will this diagnosis affect the pregnancy?