# Obstetric Cholestasis: Guidelines and Management
> Expert overview of Intrahepatic Cholestasis of Pregnancy (ICP), covering diagnostic criteria, bile acid classification, and RCOG management guidelines.

Tags: obstetric-cholestasis, pregnancy-health, rcog-guidelines, maternal-medicine, bile-acids, stillbirth-prevention, pitches-trial
## Obstetric Cholestasis Overview
- Presented by Dr. Ramshar Rafiq, SHO Obstetrics and Gynaecology at George Eliot Hospital NHS Trust.
- Defines Intrahepatic Cholestasis of Pregnancy (ICP) as a pregnancy-specific liver disorder characterized by itching (palms/soles) and raised bile acids.

## Diagnosis and Risk Factors
- **Incidence:** 0.7% of UK pregnancies; higher in South Asian women.
- **Risk Factors:** History of OC, multiple pregnancy, family history, and Hepatitis C.
- **Clinical Features:** Itching worse at night, dark urine, pale stools, and jaundice.

## Classification and Fetal Risks
- **Mild:** Bile acids 19–39 µmol/L.
- **Moderate:** Bile acids 40–99 µmol/L.
- **Severe:** Bile acids ≥ 100 µmol/L (Significantly increased stillbirth risk).

## Evidence-Based Management
- **UDCA (Ursodeoxycholic Acid):** Improves symptoms but the PITCHES Trial (2019) showed no proven reduction in stillbirth.
- **Timing of Delivery:** 
  - Mild: Delivery at term.
  - Moderate: Birth at 38–39 weeks.
  - Severe: Consider delivery at 35–36 weeks.
- **Fetal Surveillance:** CTG and scans are used but do not reliably prevent sudden stillbirth.

## Postnatal Care
- Symptoms typically resolve post-delivery.
- Requires repeat LFTs and bile acid monitoring.
- Counseling on recurrence risk (45–90% in future pregnancies).
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