“My hands and feet are itching like mad — it’s just my skin being dry”

Itching WITHOUT a rash — characteristically on the palms and soles, worse at night, in the late second/third trimester — is the classic picture of OBSTETRIC CHOLESTASIS (intrahepatic cholestasis of pregnancy), NOT "just dry skin or hormones", and must not be reassured away with moisturiser. It matters because it carries fetal risk — notably stillbirth at high bile-acid concentrations, plus preterm birth and meconium — and mandates measuring serum BILE ACIDS and LFTs, obstetric referral, increased fetal/maternal monitoring, and often planned earlier timing of birth by peak bile-acid level (RCOG GTG 43, 2022: 35–36 weeks at 100 µmol/L or more; 38–39 weeks at 40–99 µmol/L). Offer symptom relief (emollients/menthol; ursodeoxycholic acid is a maternity-team decision and RCOG GTG 43 (2022) found no perinatal benefit) but make the investigation and referral the priority. The examinable hidden agenda is minimisation ("just dry skin / don’t want to fuss") masking exhaustion and quiet worry; take it seriously, gently counter the minimisation, link the itch honestly to the baby, and — crucially — safety-net reduced fetal movements and worsening to urgent maternity assessment.