Guideline for managing ICP

Note: the information on this page was written before the third edition of the RCOG Green-Top Guideline on ICP was published on 9 August 2022. We will update the information as soon as we can, but in the meantime you can find the Guideline here.

Despite recent advances, ICP remains a complex condition to treat and manage. There are no proven drug treatments that will help all women with the condition and provide them with the reassurance that their baby is protected from the risk of stillbirth associated with the condition. There are also no drug treatments that women can take to resolve the intractable itch that many of them experience in ICP.

However, there is now research to suggest that bile acids are intrinsically linked with fetal risk and that more women can be reassured about the safety of their babies; we hope that this knowledge will be incorporated into institutional guidelines such as the Greentop 43 Guideline produced by the RCOG (Royal College of Obstetricians & Gynaecologists) and the European Association for the Study of the Liver (EASL) Guidelines. We know that a revised RCOG guideline is currently (August 2019) being drafted and we look forward to being involved with its review. Similarly, the European Guideline will be published in early 2020.

For the moment we have amended our own suggested guideline for the diagnosis, treatment and management of ICP, and this protocol is therefore suggestion based on what we know from the most current research. It has been approved by Professor Catherine Williamson (Maternal & Fetal Disease Group, King’s College London) whose clinical practice is at St Thomas’ Hospital, and King’s College Hospital, London. It may be further revised once the RCOG and European Guidelines are published.

We welcome your feedback. Please send your comments to Jenny Chambers:

This guideline suggests that some women may be able to have their babies after 37 weeks of pregnancy. However, it is important to note the following:

  • Bile acids can rise suddenly and steeply, so it is vital that bile acid results are available within 24 hours of blood being drawn.
  • No in-depth study has been made of women who progress beyond 38 weeks.
  • Researchers still need to establish the mechanism for stillbirth.
  • ICP can be debilitating for many women. The lack of sleep, constant scratching and concern about the safety of their babies mean that women often cannot face the prospect of continuing their pregnancy beyond 37/38 weeks, and this should be taken into account when deciding how to proceed.

To download a high-resolution PDF, click on the preview image:

Guideline for managing ICP.