Cholestasis (pruritus) of pregnancy
This relatively common disorder apparently results from idiosyncratic exaggeration of normal bile stasis due to hormonal changes. Intense pruritus, the earliest symptom, develops during the 2nd or 3rd trimester; dark urine and jaundice sometimes follow. Acute pain and systemic symptoms are absent. The disorder usually resolves after delivery but tends to recur with each pregnancy or with use of oral contraceptives.
For severe pruritus, oral cholestyramine Questran 4 to 6 gram twice daily or 3 to 4 gram tid is usually effective.
Bleeding due to hypoprothrombinemia occasionally develops but is readily reversed by vitamin K (phytonadione) 5 to 10 mg IM once/day for 2 to 3 days