Cholestasis of Pregnancy Checker

Intrahepatic cholestasis of pregnancy — often shortened to ICP or just cholestasis of pregnancy — is a liver condition that develops in the second half of pregnancy, most often in the third trimester. In ICP the normal flow of bile from the liver slows down, and bile acids build up in the bloodstream. The hallmark symptom is intense itching without a rash: it classically affects the palms of the hands and the soles of the feet, is often worse at night, and appears on skin that otherwise looks normal. Some people also notice dark urine, pale stools, or (less often) yellowing of the eyes or skin. ICP is the most common liver disorder of pregnancy — MedlinePlus notes it affects up to about 2 in 100 pregnancies — and although the itching usually settles within a few days of birth, it matters during pregnancy because it is linked to higher risk for the baby. That is why it is diagnosed and managed promptly rather than waited out.

You should take it seriously and call your obstetric provider — the same day if it is intense or focused on your palms and soles. Itching without a rash, especially late in pregnancy, is the exact pattern of cholestasis of pregnancy, and the only way to confirm or rule it out is a blood test for bile acids. This is not a symptom to "wait and see" on, because ICP is associated with a higher risk of complications for the baby and is managed with medication, closer monitoring, and a planned delivery. A checker like this one cannot diagnose you, and it will never tell you the itch is nothing — its whole job is to help you recognise a pattern that is worth a prompt phone call. If your provider's office is closed and the itching is severe, ask the on-call service or labor and delivery how quickly you should be seen.

With a blood test. ICP is confirmed by measuring the level of bile acids in your blood, usually alongside liver enzymes (a liver-function test); the diagnosis rests on the bile-acid result together with your symptoms. No ultrasound or scan is needed to make the diagnosis itself, though your provider may arrange monitoring of the baby once ICP is found. The Society for Maternal-Fetal Medicine (Consult Series #53) recommends measuring serum bile acids and liver transaminases when ICP is suspected. Because the itching can come before the blood levels rise, a single normal result early on does not always settle the question — if the itching continues, your provider may repeat the test. The practical takeaway is simple: the checker points at a pattern, but the answer comes from a lab, so the useful next move is always the same — call your provider and ask about a bile-acid test.

ICP matters because higher bile-acid levels are associated with an increased risk of complications for the baby, including preterm birth and, when levels are very high, stillbirth — which is why it is treated as a condition to catch and manage rather than simply endure. Management follows published SMFM and ACOG guidance and is directed by your obstetric provider or a maternal-fetal-medicine specialist. It typically includes a medicine called ursodeoxycholic acid, which SMFM recommends as the first-line treatment to ease the maternal itching; closer monitoring of the baby; and a delivery planned earlier than usual, with the exact timing based on your bile-acid levels (often around 36 to 37 weeks, and as early as about 36 weeks when levels are markedly elevated). None of this is something to start on your own — it is a clinical decision made with your provider. This tool never prescribes or times a delivery; it exists only to help you get to that conversation quickly.

The single most useful distinction is the rash. Cholestasis of pregnancy itches on skin that looks normal — there is no rash — and it favours the palms and soles. PUPPP (pruritic urticarial papules and plaques of pregnancy) is, by contrast, a rash: itchy red bumps or hives that usually begin on the belly, often within the stretch marks, and can spread to the thighs and arms. Ordinary pregnancy itching from stretching, dry skin is usually milder and localised. The reason the difference is worth pinning down is that PUPPP is uncomfortable but not known to harm the baby, whereas ICP is linked to higher risk and needs a blood test. If you have a rash, our PUPPP rash checker walks that pattern — but two cautions apply: the conditions can occur together, and only a bile-acid test can rule ICP out, so intense palm-and-sole itching is worth flagging to your provider even when there is also a rash.

Yes. This checker runs entirely in your browser: your answers are read on your own device and are never sent to a server, saved, or shared — close the tab and they're gone. There is no account, no tracking of your responses, and nothing to delete, because nothing is ever stored. We treat pregnancy data as sensitive by design. What you get back is general educational information based on published ACOG, SMFM, and MedlinePlus guidance; it isn't medical advice, a diagnosis, or a substitute for the blood test and the clinician who orders it. For anything that fits the ICP pattern, the tool's answer is always the same — talk to your obstetric provider, promptly.