# Extreme Intrahepatic Cholestasis of Pregnancy With Fetal Ascites and Neonatal Meconium Peritonitis

## TL;DR

A rare case of severe pregnancy-related liver disease led to serious fetal and neonatal complications, highlighting the need for careful monitoring and management.

## Contribution

This case report highlights the rare but severe fetal and neonatal complications associated with extreme ICP.

## Key findings

- Extreme ICP can lead to fetal ascites and neonatal meconium peritonitis.
- Multidisciplinary management allowed prolongation of pregnancy to 36 weeks.
- Neonatal bowel obstruction required surgical intervention but led to gradual recovery.

## Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a rare but potentially severe condition with significant maternal and fetal risks. A 28-year-old gravida 2 para 1 woman presented at 21 weeks’ gestation with pruritus and jaundice and was diagnosed with severe ICP (bile acids 297 μmol/L). Despite ursodeoxycholic acid (UDCA) treatment, escalation with rifampicin and antihistamines was required. At 23 weeks, fetal ultrasound revealed massive ascites and features suggestive of meconium peritonitis (MP). Intensive maternal-fetal monitoring allowed pregnancy prolongation to 36 weeks, when cesarean delivery was performed. The neonate, initially stable, developed bowel obstruction on day 7 and underwent surgical resection with ileostomy, followed by gradual recovery. This case illustrates the potential for rare but severe fetal and neonatal complications in the setting of extreme ICP. Early recognition, multidisciplinary management, and individualized delivery planning are crucial for optimizing maternal and neonatal outcomes.