Obstetric Cholestasis

What is Obstetric Cholestasis?

Obstetric cholestasis (also called intrahepatic cholestasis of pregnancy or ICP) is a liver disorder that occurs in pregnancy, typically in the third trimester. It causes bile acids to build up in the bloodstream, leading to intense itching — most commonly on the hands and feet. While the itching is distressing for the mother, the primary concern is the effect of elevated bile acids on the baby.

Why is it a Concern?

Elevated bile acids are associated with an increased risk of stillbirth, preterm birth, and fetal distress. The risk correlates with bile acid levels — higher levels carry greater risk. With appropriate monitoring and timely delivery, outcomes are generally very good.

Signs & Symptoms

• Intense itching, especially on the palms and soles of the feet
• Itching that is worse at night
• Dark-coloured urine
• Pale stools
• Mild jaundice (yellowing of the skin or eyes) — less common
• No visible rash (itching without a rash is characteristic)

How It is Monitored

Diagnosis is confirmed by blood tests measuring bile acid levels and liver function. Once diagnosed, bile acids are monitored regularly. Medication (ursodeoxycholic acid) may be prescribed to reduce bile acid levels and relieve itching. Delivery is typically planned between 37 and 38 weeks depending on bile acid levels.

Why See an MFM Specialist?

An MFM specialist can interpret bile acid trends, adjust medication, and determine the optimal timing for delivery — balancing the risk of prematurity against the risk of complications from elevated bile acids.