1 / 5

Management of Generalized Itch in Pregnancy: A Case Discussion on Cholestasis

Julie, a 35-year-old primary school teacher, presents with generalized itch at 31 weeks of gestation. Initially thought to be due to humidity during a trip to Bali, the itch persists, causing sleep disturbances. Investigations reveal elevated serum bile acids, suggesting cholestasis of pregnancy. This condition, though uncommon, can have serious implications if missed. The case emphasizes the importance of recognizing pruritus in pregnancy and understanding the need for specialist involvement in management due to potential complications.

elom
Télécharger la présentation

Management of Generalized Itch in Pregnancy: A Case Discussion on Cholestasis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Discussion: Generalised Itch May 2014

  2. Consider Julie… • Julie is a an OSC patient of yours • She is 35 yo primary school teacher, G1 P0 • She is 31/40 and her pregnancy to date has been uneventful. All routine investigations have been normal • She presents a week earlier than her scheduled review as she is finding it difficult to tolerate a generalised itch • What are the possible diagnoses? • What further information would you like from the history and examination?

  3. History & Examination: • Symptoms started 2 weeks prior whilst on a 10 day holiday in Bali • She thought it was the humidity and resort toiletries and sheets • However it has persisted on her return, she thinks it is due to the hot weather • No other symptoms apart from some general malaise and fatigue as the itch disturbs her sleep • Itch of the hands and feet are the worst, nil change in skin colour nor in colour of her urine nor faeces • No recent illness and no recent new medications • Nil past history of dermatitis • Nil past history of gallstones • Examination reveals excoriations from itching only • U/A NAD • What investigations do you order?

  4. Investigation Findings… • ALT & fasting serum Bile Acids elevated • AST, GGT, Bilirubin- normal • EBV- IgG positive only • CMV- Negative • Hepatitis serology- NAD • U/S- normal Liver & gall bladder with nil cholelithiasis visualised • What is the diagnosis? • How do you manage Julie now?

  5. Take Home Messages… • Consider the wide differential diagnosis of pruritis in pregnancy • Cholestasis of pregnancy is an uncommon (0.02-2.4% of pregnancies) but important diagnosis not to miss, pruritis can precede jaundice by 2-4 weeks • In cholestasis of pregnancy LFTs can initially be normal but eventually rises in bilirubin, ALP & GGT will occur, elevated total serum bile acid is diagnostic • The diagnosis of cholestasis requires specialist involvement in management as it can be complicated by premature birth, severe IUGR, intrapartum foetal distress and stillbirth • Cholestasis of pregnancy tends to recur in subsequent pregnancies and can be precipitated by OCP as it is genetically linked, hormonally induced • Cetirizine and promethazines are the antihistamines of choice for treatment of pruritis when cholestasis has been excluded

More Related