What is the recommended timing for delivery in patients with ICP to minimize risks to the fetus?

The recommended timing for delivery in patients with intrahepatic cholestasis of pregnancy (ICP) to minimize fetal risks is generally elective early delivery, often considered around 37 to 38 weeks of gestation. This approach aims to reduce the risk of stillbirth and other adverse perinatal outcomes associated with ICP, which tend to increase as pregnancy progresses beyond term.

Specifically, UK expert guidance and the Royal College of Obstetricians and Gynaecologists (RCOG) suggest that elective early delivery may be considered on a case-by-case basis, typically from 37 weeks onwards, to mitigate fetal mortality risks NICE CKS. This recommendation is based on expert opinion and supported by meta-analyses showing increased adverse outcomes with prolonged pregnancy in ICP Ovadia et al. 2019.

While the exact timing may be individualized depending on the severity of biochemical markers such as serum bile acid levels and liver function tests, the consensus is to avoid expectant management beyond 38 weeks due to the heightened risk of stillbirth (Ovadia et al, 2019; NICE CKS).

In summary, the balance of evidence and expert opinion supports planning delivery between 37 and 38 weeks gestation in women with ICP to minimize fetal risks, with ongoing monitoring of maternal and fetal wellbeing until delivery NICE CKS Ovadia et al. 2019.