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Key Points

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Key Points

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  • All pregnant women should be warned to report any itching in pregnancy.
  • Liver function and bile acids should always be checked in the presence of itching.
  • Liver function need not be abnormal in the presence of abnormal bile salts and itching for a diagnosis of cholestasis to be made.
  • Persistent itching but normal biochemistry should prompt repeat testing.
  • Ursodeoxycholic acid normalises biochemistry and helps itching. Randomised controlled trial data is too small to demonstrate any beneficial fetal outcome, but it is likely to be beneficial.
  • Consideration should be given to administering vitamin K to the mother in the third trimester.
  • Delivery should take place by 37 to 38 weeks, with careful intrapartum monitoring.
  • Maternal symptoms and biochemistry should return to normal post partum.



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