How is Obstetric Cholestasis Diagnosed?
C – Pregnancy-specific reference ranges for liver function tests (LFTs) should be used. C – Other causes of itching and of liver dysfunction should be excluded. C – Postnatal resolution of pruritus and LFTs should be confirmed. In obstetric cholestasis, the pruritus is typically worse at night, is often widespread, and may involve the palms of the hands or the soles of the feet. Other causes of pruritus must be excluded. The skin should be inspected and care must be taken to differentiate dermatographia artefacta (skin trauma from intense scratching), which may be seen in obstetric cholestasis, from other common skin conditions such as eczema and pruritic eruption of pregnancy. Other evidence of cholestasis should be sought, including pale stool, dark urine, and family history of obstetric cholestasis. In clinical practice, abnormalities in transaminases, gamma glutamyl transferase, bilirubin, and/or bile salts are considered sufficient to support the diagnosis of obstetric cholestasis
