Question

Treatment of choice for intrahepatic cholestasis in pregnancy is:

• A. Cholestyramine
• B. Ursodiol (ursodeoxycholic acid)
• C. Corticosteroids (dexamethasone)
• D. Antihistaminics

Hint:

Pick the drug that actually lowers maternal bile acids, not just the itch.

Answer 1

The Correct Option is B

Step 1: Recognise the condition. Intrahepatic cholestasis of pregnancy presents with intense pruritus, especially of the palms and soles, in the late second or third trimester, with raised serum bile acids and often raised transaminases. The danger is to the fetus from high circulating bile acids.

Step 2: Decide the goal of treatment. The aim is to lower maternal serum bile acids, relieve itching, and reduce fetal risk. The drug that does this best is ursodeoxycholic acid.

Step 3: Explain why ursodiol is first line. Ursodeoxycholic acid improves bile flow, lowers the concentration of toxic hydrophobic bile acids, relieves pruritus, and improves liver enzymes. It is the recommended treatment of choice and is considered safe in pregnancy.

Step 4: Reject the alternatives. Cholestyramine (A) binds bile acids in the gut but is less effective for itch, worsens fat malabsorption, and can lower vitamin K and worsen bleeding risk, so it is second line at best. Corticosteroids (C) and antihistamines (D) give only limited or symptomatic benefit and do not address bile acids, so they are not the treatment of choice.

Answer: Ursodiol (ursodeoxycholic acid) (Option B).