Intrahepatic cholestasis of pregnancy is a rare disorder, predominately occurring during the third trimester of pregnancy and characterized by pruritus, jaundice, and biochemical disturbances in liver enzymes. While intrahepatic cholestasis of pregnancy poses little maternal risk, there is significant risk to the fetus such as preterm delivery, non-reassuring fetal status, meconium staining, and perinatal mortality. Current evidence proposes susceptibility to derangements in the sulfation of steroid compounds, affecting the metabolism of progesterone and bile acids in the fetal/placental compartment. Treatment with ursodeoxycholic acid is suggested, coupled with close maternal-fetal surveillance and delivery as close to term as possible.