Nearly 0.2% to 2% of pregnancies are complicated by intrahepatic cholestasis of pregnancy (ICP) which can lead to increased fetal risks in pregnancy.

A review directs womens health care providers regarding the diagnosis, management, and fetal risks associated with ICP.

The following are the highlights-

• The diagnosis of ICP is established on symptoms of pruritus that are characteristically present over palms and soles, and have elevated bile acid levels. 
• Other liver function tests like alanine aminotransferase and aspartate aminotransferase are also often elevated.
• Other causes of liver dysfunction should be ruled out. 
• ICP may have an increased risk of preterm birth, meconium-stained amniotic fluid, respiratory distress syndrome, or stillbirth in the fetus. 
• Evidence suggests an increase in the level of bile acid to be directly proportional to the risk of adverse neonatal outcomes. 
• Ursodeoxycholic acid treatment may improve maternal pruritus symptoms, and biochemical tests, but no treatment can definitively improve fetal outcomes.

Thus, Health care providers must be acquainted with the signs and symptoms of ICP and deliver accurate diagnosis and management of affected women. Women with a diagnosis of ICP should be managed with ursodeoxycholic acid to improve maternal symptoms. Since there is an increased risk of stillbirth in the setting of ICP, the delivery may be considered at 37 weeks gestation.

Source- Wood AM, Livingston EG, Hughes BL, Kuller JA. Intrahepatic Cholestasis of Pregnancy: A Review of Diagnosis and Management, Obstetrical & Gynecological Survey, 2018;73(2): 103-109. doi: 10.1097/OGX.0000000000000524