A Case Report of Early-Onset Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder unique to pregnancy, typically manifesting in the late second or third trimester. We report a rare case of early-onset ICP diagnosed at 18 weeks of gestation in a 27-year-old primigravida who presented with generalized pruritus, predominantly involving the palms and soles, and associated dark urine. There was no past medical or family history of liver disease. Clinical examination was unremarkable apart from scratch marks. Laboratory evaluation revealed elevated serum bile acids and transaminases, while viral hepatitis markers and autoimmune profile were negative. Abdominal ultrasound excluded gallstones or biliary obstruction. A diagnosis of ICP was made. The patient was initiated on ursodeoxycholic acid with significant symptomatic relief and normalization of liver enzymes. She was closely monitored with serial bile acid levels and fortnightly fetal surveillance. At 36 weeks, labor was induced, and she delivered a healthy neonate without complications. This case highlights the importance of considering ICP even in early gestation, as timely recognition and appropriate management are crucial to reduce the risks of maternal morbidity and adverse perinatal outcomes.