This protocol covers the management of severe intrahepatic cholestasis of pregnancy (ICP) in which the patient presents with itching on skin of normal appearance and a peak total bile acid concentration of 100 micromol/L or more.

Clinical Scenario

ICP is considered in pregnant patients who experience itching on skin of normal appearance with raised peak total bile acid concentrations. The severe form is defined by itching alongside peak bile acid concentrations of 100 micromol/L or more — a threshold that identifies a clinically distinct, higher-risk subset requiring a specific management pathway.

Treatment Approach

For early-onset severe disease, obtaining specialist input is the essential first step, after which specific individualised pharmacological treatment may be considered — the full protocol details the criteria and the options that apply.

References

The diagnosis of ICP should be considered in pregnant women who have itching in skin of normal appearance and raised peak random total bile acid concentration of 19 micromol/L or more.
Severe ICP Itching and raised peak bile acid concentrations ≥100 micromol/L
In women and pregnant people with early-onset severe disease, an opinion from a specialist in ICP should be sought before considering rifampicin treatment.
Do not offer other agents for treatment of ICP outside of a research study or individualised specialist treatment

DOI: 10.1111/1471-0528.17206 View source ↗

Treatment of Severe Cholestasis of Pregnancy: Itching with Normal-Appearing Skin and Peak Bile Acids ≥100 µmol/L

Clinical Scenario

Treatment Approach

References