Recurrent Intrahepatic Cholestasis of Pregnancy with History of Fetal Demise

Intrahepatic cholestasis of pregnancy (ICP) is a rare, potentially fatal liver disorder that occurs in late pregnancy. It is characterized by pruritus, jaundice, and elevated liver enzymes, with spontaneous relief of signs and symptoms after birth. Early detection and treatment are required due to the potential risk of fetal complications, including fetal death. A 30-year-old woman with deeply icteric sclera and skin scratch marks presented to a gastroenterology-hepatology referral clinic. Her liver enzymes, bilirubin levels, and serum bile acid levels were all abnormally high. She also disclosed similar symptoms in her previous pregnancy, which resulted in fetal death at the sixth month. With a presumptive diagnosis of recurrent ICP, the patient was started on ursodeoxycholic acid (UDCA) pills, which significantly improved her pruritus and returned her bile acid levels to normalcy after 2 months of treatment. The delivery was uneventful. We believe that a proper diagnosis combined with UDCA treatment and vigilant obstetric follow-up significantly reduced the patient's symptoms and prevented a possible intrauterine death.