Objective: To draw attention to the role of elevated levels of bile acids and liver enzymes in intrahepatic cholestasis of pregnancy (ICP) on the course of pregnancy. Literary overview of the complications associated with ICP. Design: Case report. Setting: Department of Obstetrics and Gynecology, Regional Hospital, Pardubice. Subjects and methods: The author analyses four cases of highly elevated liver enzymes in late pregnancy. Together with statements in literature she describes the recommendations for the best management of ICP to prevent poor fetal outcome including intrauterine fetal demise, increased incidence of meconiumstained amniotic fluid and fetal intolerance of labour. Conclusion: Fetal mortality appears to be secondary to acute anoxic events, rather than chronic uteroplacental insufficiency. Early delivery when indicated appears the only strategy currently demonstrated to improve outcomes. The levels of bile acids can help the clinicians to make the decision.

        Key words: intrahepatic cholestasis of pregnancy, liver disease, bile acids, pruritus, pregnancy