Intrahepatic cholestasis of pregnancy ⚠️ 🤰
🧠 Clinical mechanism: Pregnancy-associated bile acid dysregulation produces pruritus and can be associated with fetal risk at higher bile acid concentrations.
🔎 Recognise
- Itching, often palms/soles and worse at night, classically without a primary rash; consider other liver and skin conditions.
🛟 First assessment and action
- Refer to maternity services for assessment and safety-netting, particularly with reduced fetal movements or jaundice.
🧪 Investigations and reassessment
- Serum bile acids and liver function tests; repeat when itching persists despite normal initial results.
⚠️ Pitfall / escalation
- Bile acids may be abnormal despite normal LFTs. Delivery timing depends on bile acids, gestation and risk factors, not a single itch severity score.
UK reference: Primary NHS/NICE/RCOG/GMC source.
Editorial draft, 7 November 2026: targeted source-supported educational summary, NOT independent consultant/pharmacist verification or a treatment protocol. Follow up-to-date BNF, NICE and local NHS pathways.
Related: Normal pregnancy and Antenatal care · Reduced/change in fetal movements