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ALL / Gastroenterology

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) affects around 1% of pregnancies in the UK. It is associated with an increased risk of premature birth.

Features
  • Pruritus - may be intense - typical worse palms, soles and abdomen
  • No rash
  • Raised bile acids (diagnostic; ≥19 µmol/L)
  • Mild elevation of ALT / AST
  • Normal or mildly raised bilirubin

Management
  • Stillbirth risk only rises significantly when bile acids ≥100 µmol/L
    • Mild ICP (19–39 µmol/L): risk similar to background; consider planned birth by 40 weeks or routine antenatal care.
    • Moderate ICP (40–99 µmol/L): risk remains low until 38–39 weeks; consider delivery at 38–39 weeks.
    • Severe ICP (≥100 µmol/L): increased stillbirth risk; consider delivery at 35–36 weeks.
  • Symptomatic relief of itch with emollients
  • No treatments improve fetal outcomes
    • Do not routinely use ursodeoxycholic acid to reduce perinatal risk.

Recurrence of intrahepatic cholestasis of pregnancy is 45-90% in subsequent pregnancies.
+PassMedicine Notes

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) affects around 1% of pregnancies in the UK. It is associated with an increased risk of premature birth.

Features
  • Pruritus - may be intense - typical worse palms, soles and abdomen
  • No rash
  • Raised bile acids (diagnostic; ≥19 µmol/L)
  • Mild elevation of ALT / AST
  • Normal or mildly raised bilirubin
Management
  • Stillbirth risk only rises significantly when bile acids ≥100 µmol/L
    • Mild ICP (19–39 µmol/L): risk similar to background; consider planned birth by 40 weeks or routine antenatal care.
    • Moderate ICP (40–99 µmol/L): risk remains low until 38–39 weeks; consider delivery at 38–39 weeks.
    • Severe ICP (≥100 µmol/L): increased stillbirth risk; consider delivery at 35–36 weeks.
  • Symptomatic relief of itch with emollients
  • No treatments improve fetal outcomes
    • Do not routinely use ursodeoxycholic acid to reduce perinatal risk.

Recurrence of intrahepatic cholestasis of pregnancy is 45-90% in subsequent pregnancies.



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