Intrahepatic cholestasis of pregnancy

ICP presents as pruritus typically in the third trimester and is associated with adverse fetal outcomes such as preterm labor, meconium-stained amniotic fluid, and stillbirth.[7] The risk of these adverse fetal outcomes is correlated with peak bile acid levels.[6] The risk of preterm labor and meconium-stained amniotic fluid is associated with peak BA > 40, and the risk of stillbirth is associated with peak BA > 100.[4] UDCA is beneficial for the treatment of pruritus, and data suggests it lowers the risk of spontaneous preterm birth and meconium-stained amniotic fluid.[4] To reduce the risk of stillbirth, guidelines have recommended early delivery for women with ICP.[1] Many of the reported adverse perinatal outcomes associated with ICP are actually complications of preterm birth, such as low birth weight and NICU utilization.[1] Newer guidelines recommend stratifying early delivery based on peak bile acid level to balance the risks of iatrogenic preterm birth with risks of adverse fetal effects from ICP (Figure 1).