A 27-year-old woman presents at 37 weeks of gestation with severe itching, particularly on the palms of her hands and soles of her feet, but with no rash. Liver function tests reveal elevated serum bile acids. What are the potential diagnoses, and what are the next steps?
The woman's presentation is suggestive of intrahepatic cholestasis of pregnancy (ICP), a condition characterized by severe itching and elevated serum bile acids. It can pose risks to the fetus, including preterm birth, fetal distress, and stillbirth. The next steps would involve confirming the diagnosis with serum bile acid levels, and initiating treatment with ursodeoxycholic acid to reduce serum bile acids and improve itching. Delivery is typically planned around 37 weeks due to the increased risk of stillbirth.