INTRODUCTION: Fetal death from intrahepatic cholestasis of pregnancy can be a sudden event and is not reliably predicted by findings on fetal heart rate tracing. Our objective is to assess whether there are differences in antenatal testing and delivery outcomes between patients with severe compared with mild intrahepatic cholestasis of pregnancy. METHODS: This is a retrospective analysis on 87 patients with intrahepatic cholestasis of pregnancy who underwent antenatal testing and subsequent delivery at a single institution. Patients with severe intrahepatic cholestasis of pregnancy were defined as having total bile acids levels greater than 40 IU/mL, whereas those with mild intrahepatic cholestasis of pregnancy had total bile acids of less than 40 IU/mL. The primary outcome was the presence of decelerations in antenatal testing. Secondary outcomes included birth weight, delivery route, meconium, and neonatal intensive care admission. Fisher's exact, [chi]2, and Mann-Whitney U tests were used as indicated. RESULTS: Eighty-seven patients were identified; 20 had severe intrahepatic cholestasis of pregnancy, whereas 67 had mild intrahepatic cholestasis of pregnancy. The severe group had significantly higher median total bile acids (P=.001), alkaline phosphatase (P=.006), and aspartate and alanine aminotransferase levels (P=.001; Table 1). There were no differences between the two groups in fetal heart rate at baseline or presence of decelerations. Patients with severe intrahepatic cholestasis of pregnancy were older (33 [26.5-36] compared with 27.7 [22.25-32] years, P=.024). Cesarean delivery rate, meconium, and neonatal intensive care unit admission were not different ( Table 2).