Obstetrics

Question 1

Rash - third trimester, itchy papular rash, first appearing on striae but can spread to entire abdo, thighs and buttocks and can progress to widespread eczematous rash with fluid-filled vesicles

Answer 1

Polymorphic eruption of pregnancy (PEP) aka pruritic urticarial papules and plaques of pregnancy (PUPPP)

Question 2

Itching of palms and soles (no rash)

Answer 2

Obstetric cholestasis aka intrahepatic cholestasis of pregnancy

Question 3

What is raised in obstetric cholestasis/intrahepatic cholestasis of pregnancy?

Answer 3

Bile acids/salts

Question 4

Why can obstetric cholestasis cause a rash?

Answer 4

Intense pruritus which develops into rash

Question 5

How is obstetric cholestasis treated? How can the itchy rash in obstetric cholestasis be treated?

Answer 5

A - Ursodeoxycholic acid (UDCA), rash - emollients, antihistamines

Question 6

Rash - itchy, eczema-like in flexural areas, most common in women with history of eczema, typically appears early in pregnancy (first or second trimester), typically on face, neck, chest and flexor surfaces of upper limb

Answer 6

Atopic eruption of pregnancy

Question 7

Rash - itchy, typically forms around umbilicus and progresses to form blisters, autoimmune, likely to flare up again throughout pregnancy (rare)

Answer 7

Pemphigoid gestationis aka gestational pemphigoid (previously herpes gestationis)

Question 8

How are pregnancy related rashes treated? (polymorphic eruption of pregnancy (PEP) aka pruritic urticarial papules and plaques of pregnancy (PUPPP), atopic eruption of pregnancy, obstetric cholestasis rash)

Answer 8

Emollients, topical corticosteroids

Question 9

Erythematous bands, not itchy, can appear on abdomen, thighs and buttocks during pregnancy

Answer 9

Striae gravidarum (stretch marks)