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from Section 3 - Antepartum (Late Pregnancy)
Published online by Cambridge University Press: 08 April 2025
Intrahepatic cholestasis of pregnancy is a transient disorder that typically occurs during the second and third trimesters. It is characterized by pruritis, most intensely along palms and soles of feet, and elevated serum bile acids. While it does not pose any maternal risks outside of discomfort, it does increase fetal risks of stillbirth, preterm labor (spontaneous and iatrogenic), and meconium-stained fluid. Once the diagnosis is made, treatment with ursodeoxycholic acid should be initiated. This medication works to provide symptomatic relief of pruritis and improve laboratory abnormalities. Antenatal fetal testing should begin at diagnosis or at 32 weeks. Delivery is indicated at 36 0/7–39 0/7 weeks if bile acids are 10–100 µmol/L and at 36 0/7 weeks if bile acids are >100 µmol/L. If delivery is performed prior to 37 0/7 weeks’ gestation, corticosteroids should be administered.
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