Clinical Expert Series
Intrahepatic Cholestasis of Pregnancy
Catherine Williamson, MD, and Victoria Geenes, MBBS, PhD
Obstet Gynecol 2014;124(1)
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
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equivalent to College Cognate Credits.
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Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-479-0830).
Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be recorded for
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Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout of
the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “Intrahepatic Cholestasis of Pregnancy” will be available through July 2017.
1. The most common cause of pregnancy-specific liver disease that typically presents in the third
trimester is:
Common duct gallstone
Intrahepatic cholestasis
Fatty liver
Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
Moderate-to-severe preeclampsia
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(1)
Credit available through July 2017
Page 1 of 3
2. Intrahepatic cholestasis of pregnancy is most commonly treated by:
Laparoscopic surgery
Ursodeoxycholic acid
Lithotripsy
Dialysis
Cholestyramine oral therapy
3. The pruritus of intrahepatic cholestasis of pregnancy typically involves the:
Abdomen
Breasts
Scalp
Palms and soles
Perineum
4. Intrahepatic cholestasis can recur with the use of:
Long-acting progestins
Combination oral contraceptives
Anticholinergic therapy
Nicotinic acid therapy
Diuretics
5. The risk of complications of intrahepatic cholestasis for the fetus is associated with the maternal
serum level of:
Ammonia
Bile acids
Bilirubin
Aspartate aminotransferase (AST)
Alkaline phosphatase
6. Susceptibility to intrahepatic cholestasis of pregnancy is based upon:
Viral exposure
Genetics
Hormonal contraceptive use
High-fat diet
Statin use
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(1)
Credit available through July 2017
Page 2 of 3
7. Environmental factors reported to play a role in the etiology of intrahepatic cholestasis of pregnancy
include levels of dietary:
Calcium
Selenium
Sodium
Potassium
Vitamin K
8. For patients with intrahepatic cholestasis, evidence for management strategies involving increased
antenatal surveillance and elective early delivery are:
Based upon randomized trials
Based upon cohort studies
Based upon case-series
Based upon consensus
Limited and inconsistent
9. The diagnosis of intrahepatic cholestasis is based upon:
Clinical symptoms
Elevated maternal serum bile acids
Estrogen challenge testing
Ultrasonography
Elevated maternal white blood count
10. Studies suggest that the threshold for significant fetal risk in women with intrahepatic cholestasis of
pregnancy occurs above a threshold of:
5 micromoles/L
10 micromoles/L
20 micromoles/L
40 micromoles/L
60 micromoles/L
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(1)
Credit available through July 2017
Page 3 of 3