A Case Report of Early Onset Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder occurring in pregnancy presenting with pruritus and the presence of increased levels of serum bile acid. Early onset ICP occurs when this presents before 24 weeks of gestation. This is a rare presentation but can pose a great clinical dilemma. Most often, there are no considerable maternal problems from ICP other than pruritus, which sometimes significantly impacts the quality of life. However, there can be adverse foetal outcomes and complications such as stillbirth. We present the case of an early onset presentation of ICP in a 27-year-old primigravid woman with pruritus and rapidly rising serum bile acid concentration. This report highlights the clinical course and presentation, diagnostic workup, and management approach. In the second trimester, the patient's bile acid levels rose rapidly from 15 μmol/L to 273 μmol/L (normal range: 0-18 μmol/L) over a short time. Her alanine aminotransferase also increased from 22 U/L to 141 U/L (normal range: 0-55 U/L). This prompted close feto-maternal monitoring and swift, robust intervention. She later on went into preterm labour at 30 weeks' gestation and delivered via category 1 lower segment caesarean section due to foetal distress in labour. We highlight through this case that early recognition, close monitoring, and multi-disciplinary care are key to optimise maternal and foetal outcomes in early onset ICP.