Generalized pruritus in pregnancy: a clinical case

Abstract

Case-History: A 20 year old woman presented to the prenatal clinic with generalised pruritus 35 weeks into her pregnancy. Based on history and physical examination data, the following diagnoses were considered: intra-hepatic cholestasis of pregnancy, Besniers prurigo gestationis, papular and plaque urticaria with pruritus, obstruction of the billiary ducts, or viral hepatitis. Ancillary exams were ordered, and the patient was referred to a hospital obstetrics clinic, since some of the diagnoses above would require corresponding maternal and foetal surveillance. The ancillary exams and clinical evolution confirmed a diagnosis of intra-hepatic cholestasis of pregnancy. The authors briefly mention the epidemiological, clinical and therapeutic aspects of this condition, as well as the differential work-out for a case of pruritus in pregnancy. The relevance of hospital referral to reduce adverse perinatal outcomes is highlighted.