Obstetrics

Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy causes pruritus without a primary rash and raised bile acids, usually late in pregnancy; peak bile acids stratify stillbirth risk and guide shared decisions about monitoring and planned birth.

Definition

Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, usually in the second half of pregnancy, characterised by otherwise unexplained pruritus and a peak random serum bile-acid concentration of at least 19 micromol/L, with or without abnormal liver tests. It usually improves after birth but is associated with bile-acid-dependent fetal risk.

First principles

Itch without a primary rash is the signal

ICP usually presents with generalised itch, often worse at night and involving the palms or soles, with no primary rash. Excoriations may be present. Itch is common in pregnancy and most people with itch do not have ICP, so check bile acids and liver tests and reassess if symptoms persist despite initially normal results.

You’ve reached the end of the preview

The rest of this extended textbook page is part of full access. Create a free account to read the sample topics in full and try sample questions, then upgrade to unlock every high-yield and extended page, plus the complete question bank.

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.