TY - JOUR T1 - Does ursodeoxycholic acid have a role in the treatment of women with intrahepatic (obstetric) cholestasis of pregnancy anymore? JF - BMJ Evidence-Based Medicine JO - BMJ EBM SP - 69 LP - 70 DO - 10.1136/bmjebm-2019-111292 VL - 26 IS - 2 AU - Francis Githae Muriithi Y1 - 2021/04/01 UR - http://ebm.bmj.com/content/26/2/69.abstract N2 - This EBM verdict piece explores the implications of the PITCHES trial, which examined the effect of ursodeoxycholic acid on perinatal outcomes in women with intrahepatic (obstetric) cholestasis of pregnancy. The acronym PITCHES is drawn from the full title of the trial: P hase III trial in I ntrahepa T ic CH olestasis of pregnancy (ICP) to E valuate ur S odeoxycholic acid (UCDA) in improving perinatal outcomes. Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy, is a pregnancy-specific condition characterised by pruritus most commonly but not exclusively, of the hands and soles of the feet, abnormal liver function tests, raised bile acids and resolution in the postpartum period. It affects about 0.7% of pregnant women in the UK and 0.2%–2.0% of pregnant women worldwide with geographical and ethnic variation in incidence that has been speculated to be due to genetic differences.1 Risk factors include Asian ethnicity (Pakistani and Indian), Chilean, indigenous Americans, family history, multifetal pregnancy, assisted reproductive treatment and being of higher maternal age.2 A systematic review and individual patient data meta-analysis published in 2019 examined epidemiological studies for the association of stillbirth and associated outcomes in relation to … ER -