tailieunhanh - Case lâm sàng sản khoa - Case 2

Tham khảo tài liệu 'case lâm sàng sản khoa - case 2', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 20 A 24-year-old Ì1 1 0 at 28 weeks gestation complains of a 2-weck duration of generalized pruritus. She denies rashes exposures to insects or allergies. Her medications include prenatal vitamins and iron supplementation. On examination her BP is 100 60 HR is 80 bpm and weight is 140 lb. She is anicteric. The skin is without rashes. The fetal heart tones arc in the 140-bpm range. What is the most likely diagnosis 1 76 SI I II I s OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 20 Pruritus Cholestasis of Pregnancy Sumniarv A 24-year-old Cỉl PO at 28 weeks gestation complains of a 2-week duration of generalized pruritus. She is anicteric and nor-motensive. The skin is without rashes. The fetal heart tones are in the 140-hpm range. Most likely diagnosis Cholestasis of pregnancy. Analysis Objectives 1. Know the differential diagnosis of pruritus in pregnancy. 2. Understand the clinical presentation of cholestasis of pregnancy. 3. Know that the first line of treatment of cholestasis of pregnancy is an oral antihistamine. Considerations This 24-ycar-old woman who is at 28 weeks gestational age complains of generalized pruritus. The systemic location of the itching and lack of rash makes a contact dermatitis unlikely. Another cause of pruritus unique to pregnancy is pruritic urticarial papules and plaques of pregnancy PUPPP which are erythematous papules and hives beginning in the abdominal area and often spreading to the buttocks. This is unlikely as the patient docs not have a rash. This patient s clinical picture docs not resemble herpes gestationalis a condition causing intense itching but associated with erythematous blisters on the abdomen and extremities. Thus the most likely etiology in this case is intrahcpalic cholestasis a process in which bile salts are incompletely cleared by the liver accumulate in the body and arc deposited in the dermis causing pruritus. This disorder usually begins in the third trimester. There arc no associated skin rashes other than .