This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Medical, surgical and gynaecological illness complicating pregnancy, Subject name: Gynaecology & Obstetrics
Mrs. X, Primigravida at 36weeks complains of generalized pruritis with increased intensity in soles. Diagnosis is 
Select and explain. 
A. Intrahepatic cholestasis of pregnancy, B. HELLP, C. Viral hepatitis, D. Acute fatty liver of pregnancy
A: Intrahepatic cholestasis of pregnancy
Answer: A: Intrahepatic cholestasis of pregnancy 
Explanation: Clinical presentation of Intrahepatic Cholestasis of Pregnancy:Pruritus develops in late pregnancy, although it occasionally manifests earlier. There are no constitutional symptoms, and generalized pruritus shows a predilection for the soles. Skin changes are limited to excoriations from scratching. Biochemical tests may be abnormal at presentation, but pruritusmay precede laboratory findings by several weeks. Approximately 10 percent of women have jaundice.Ref: William&;s Obstetrics; 24th edition; Chapter 55