Intrahepatic Cholestasis of Pregnancy (ICP)—also called obstetric cholestasis—is a liver condition that occurs during pregnancy and causes a build-up of bile acids in the bloodstream. ⭐ Key Features 1. When it occurs Typically in the third trimester, though it can start earlier. 2. Main symptoms Severe itching, especially on palms of hands and soles of feet (usually worse at night) Dark urine Pale stools Jaundice (less common) ⭐ Why it happens Hormonal changes during pregnancy can slow or block bile flow from the liver. Bile acids then accumulate in the bloodstream, leading to maternal symptoms and potential fetal risks. ⭐ Diagnosis ICP is diagnosed based on: Elevated total bile acids (generally 10 μmol/L) Liver function tests may show elevated ALT/AST Other causes of liver disease must be ruled out ⭐ Risks For the mother Severe itching Mild liver dysfunction (resolves after birth) For the baby Preterm birth (spontaneous or planned) Meconium-stained amniotic fluid Fetal distress Rare but serious risk of stillbirth, especially if bile acids are very high (100 μmol/L) ⭐ Treatment Ursodeoxycholic acid (UDCA) → helps lower bile acids and relieves itching Topical soothing agents (e.g., menthol creams) Antihistamines may help with sleep Regular monitoring: Weekly or biweekly liver tests and bile acids Fetal surveillance (if indicated) ⭐ Delivery planning Many guidelines recommend planned delivery around 36–37 weeks, especially if bile acids are significantly elevated, to reduce stillbirth risk. ⭐ After birth