Understanding Intrahepatic Cholestasis of Pregnancy (ICP)
Understanding Intrahepatic Cholestasis of Pregnancy (ICP)
What is Intrahepatic Cholestasis of Pregnancy (ICP)?
ICP, also known as intrahepatic cholestasis of pregnancy or obstetric cholestasis (OC) is a liver condition that occurs during pregnancy. It affects the flow of bile acids from the liver, causing them to build up in the body. It typically appears in the third trimester and resolves after birth.
What are the symptoms?
• Itching (often severe), especially on the hands and feet
• Itching may be worse at night
• Occasionally, dark urine or pale stools
• Jaundice (yellowing of skin or eyes) in some cases
Note: There is usually no rash. If you have a rash, it may be due to another cause.
How is Intrahepatic Cholestasis of Pregnancy (ICP) diagnosed?
Diagnosis is based on symptoms and blood tests:
• Liver function tests (LFTs)
• Serum bile acids
These tests are repeated regularly to monitor the condition.
Why is ICP important?
ICP can increase the risk of:
• Preterm birth (spontaneous or induced)
• Meconium-stained liquor
• Stillbirth (especially when bile acid levels are high)
The risk of stillbirth is greatest when bile acid levels are ≥100 µmol/L.
How is Intrahepatic Cholestasis of Pregnancy (ICP) managed during pregnancy?
• Regular blood tests (LFTs and bile acids) – frequency depends on severity
• Ursodeoxycholic acid (UDCA) may be prescribed to reduce bile acids and relieve itching
• Vitamin K supplements may be given if your clotting levels are affected
• CTG monitoring (baby’s heartbeat) may be offered from around 37 weeks
• Early delivery is often planned (typically between 37–39 weeks), depending on bile acid levels
What happens after birth?
• ICP usually resolves within a few days after birth
• Your liver tests should return to normal
• It does not affect long-term liver health in most women
• You may be offered a postnatal blood test to ensure levels have normalised
What is the risk of recurrence of Intrahepatic Cholestasis of Pregnancy (ICP)?
ICP has a high recurrence rate:
• It returns in 60–90% of future pregnancies
• It may occur earlier and be more severe in subsequent pregnancies
Monitoring for Intrahepatic Cholestasis of Pregnancy (ICP) in future pregnancies
If you’ve had ICP before, your pregnancy will be monitored more closely:
• Early referral to obstetric care
• Baseline LFTs and bile acids around 12–16 weeks gestation
• Repeat tests if symptoms appear, particularly itching
• Routine bile acid testing from 28 weeks, even if you are asymptomatic
• Weekly or fortnightly monitoring of bile acids and LFTs if ICP recurs
• Delivery planning based on severity – often around 37 weeks, earlier if bile acids ≥100 µmol/L
You should inform your midwife and GP as soon as you become pregnant again.
Can I do anything to prevent Intrahepatic Cholestasis of Pregnancy (ICP)?
There is currently no proven way to prevent ICP. However, early monitoring and planning can significantly reduce risks to you and your baby.
Learn More
Royal College of Obstetricians and Gynaecologists (RCOG) – ICP Guidance
When to seek urgent help
Contact your midwife or maternity unit if:
• You develop itching, especially on hands and feet
• Your itching worsens
• You notice dark urine, pale stools, or jaundice
• You feel reduced baby movements
You may also be referred to a specialist NHS maternal medicine team for more complex care.
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