This is a good overview of the condition. Remember – it is a diagnosis of exclusion.
- Pruritus without a rash (except excoriation). It is often worse at night and affects palms and soles too.
- Cholestatic symptoms (pale stool / dark urine / jaundice)
- Deranged LFT (transaminases / gamma-GT – bilirubin and bile acids may also be raised). Beware; LFT can take weeks to rise, so if the woman has persistent pruritus, measure LFT every 1 to 2 weeks.
- To exclude other causes of liver disease – Hep ABC screening, EBV, CMV, Liver autoimmune screen, Coagulation screen
- Refer to obstetrics (need weekly LFT / regular BP and dipstix to check for pre- eclampsia, which is a differential diagnosis)
- Emollients / Chlorphenamine
- Other drugs are secondary care (eg ursodeoxycholic acid / dexamethasone)
- Post-delivery follow-up in secondary care – women need to be advised of the following:
- Higher risk in subsequent pregnancy
- Higher risk to family members
- Need to avoid oestrogen containing contraceptives
- No long term physical sequelae to baby / mum
- Recheck LFT (normally at about 6/52).