Cholestasis of Pregnancy

• Benign dermatosis due to cholestasis; multifactorial and typically in third trimester (± second trimester)
• Presents with intense generalized pruritus (worse at night, worse on trunk/ palms/soles), ± dark urine, light-colored stools, jaundice; resolves 1–2 weeks after delivery, ± recurrence with subsequent pregnancies and OCPs, ↑ risk of cholelithiasis or gallbladder disease
• Histology: not needed (diagnosis per labs)
• Labs: ↑ serum bile acids, ↑ direct bilirubin
• Fetal risk (controversial): ↑ incidence of stillbirth, meconium staining and premature labor
• Treatment: cholestyramine, ursodeoxycholic acid (UDCA), phototherapy, vitamin K supplementation if intrahepatic cholestasis > few weeks (causes impaired K absorption and prolonged PT); resolves 1–2 days after delivery