Antenatal care: cholestasis: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Antenatal care: cholestasis

Sample item

A woman at 33 weeks has severe itching of the palms and soles, worse at night, without a rash. Serum bile acids are 45 micromol/L and transaminases are mildly raised. What is the diagnosis and the usual treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intrahepatic cholestasis of pregnancy, treated with ursodeoxycholic acid and planned delivery around 37 to 38 weeks

Intrahepatic cholestasis of pregnancy presents in the third trimester with pruritus without rash and raised bile acids, and carries a risk of stillbirth, preterm labour and meconium. Ursodeoxycholic acid relieves itching, and delivery is typically planned at 37 to 38 weeks, earlier with very high bile acids. Vitamin K is given when prothrombin time is prolonged.

Option by option

  • A. Acute fatty liver of pregnancy, treated with oral antihistamines

    Acute fatty liver of pregnancy is an obstetric emergency with hypoglycaemia and liver failure, not isolated itching.

  • B. Intrahepatic cholestasis of pregnancy, treated with ursodeoxycholic acid and planned delivery around 37 to 38 weeks (correct)

    Correct. Itching without rash and raised bile acids define this disorder, which needs monitoring and timely delivery.

  • C. Pruritic urticarial papules and plaques of pregnancy, treated with immediate delivery

    PUPPP causes an itchy rash on striae and is benign for the fetus.

  • D. Hyperemesis gravidarum, treated with intravenous fluids

    Hyperemesis occurs early and is characterised by vomiting.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Intrahepatic cholestasis of pregnancy, treated with ursodeoxycholic acid and planned delivery around 37 to 38 weeks. Intrahepatic cholestasis of pregnancy presents in the third trimester with pruritus without rash and raised bile acids, and carries a risk of stillbirth, preterm labour and meconium.

Why is "Acute fatty liver of pregnancy, treated with oral antihistamines" not the answer?

Acute fatty liver of pregnancy is an obstetric emergency with hypoglycaemia and liver failure, not isolated itching.

Why is "Pruritic urticarial papules and plaques of pregnancy, treated with im…" not the answer?

PUPPP causes an itchy rash on striae and is benign for the fetus.

Why is "Hyperemesis gravidarum, treated with intravenous fluids" not the answer?

Hyperemesis occurs early and is characterised by vomiting.

What concept does this question test?

It tests Antenatal care: cholestasis in OBG. Ursodeoxycholic acid relieves itching, and delivery is typically planned at 37 to 38 weeks, earlier with very high bile acids. Vitamin K is given when prothrombin time is prolonged.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antenatal care: cholestasis?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.