A 33-Year-Old Primigravida at 32 Weeks Gestation Comes to the Office

A 33-year-old primigravida at 32 weeks gestation comes to the office due to severe generalized itching that is most intense on her hands and feet.  Her pregnancy has been uncomplicated so far.  The patient has no other medical conditions and her only medication is a daily prenatal vitamin.  She does not use tobacco, alcohol, or illicit drugs.
Blood pressure is 106/60 mm Hg, pulse is 56/min, and respirations are 12/min.  Skin examination shows excoriations on her forearms and anterior shins.  The abdomen is nontender and there is no hepatosplenomegaly.  The remainder of the physical examination is within normal limits.
Laboratory results are as follows:
Viral hepatitis panel is negative.  Abdominal ultrasound reveals normal liver echogenicity and no dilated bile ducts.
Which of the following is the most appropriate next step in management of this patient?

A) Cholestyramine
B) Emergent cesarean delivery
C) N-acetylcysteine
D) Prednisolone
E) Ursodeoxycholic acid

Correct Answer:

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