A 36-year-old woman, gravida 2 para 1, at 32 weeks of gestation presents to the GP with pruritus of her palms and soles, worse at night. Bile acids re...

Question

A 36-year-old woman, gravida 2 para 1, at 32 weeks of gestation presents to the GP with pruritus of her palms and soles, worse at night. Bile acids return at 14 µmol/L and ALT is within normal limits. She asks whether this excludes obstetric cholestasis. Which is the single most appropriate advice?

Accepted Answer

Bile acids should be repeated weekly as levels can rise over time, and the diagnosis is not excluded by a single normal or borderline result

Answer

Bile acids

Answer

Start ursodeoxycholic acid immediately regardless of bile acid levels

Answer

Perform a liver biopsy to confirm the diagnosis

Answer

Pruritus without raised bile acids is always dermatological and requires dermatology referral

uk-drcog MCQ (SBA): Borderline Bile Acids - Serial Monitoring