Intrahepatic cholestasis of pregnancy (ICP) is a critical late-pregnancy complication characterized by pruritus and elevated serum bile acid levels, which can lead to severe perinatal complications. Risk factors for ICP include maternal age, BMI, hepatitis B infection, and more. The condition’s incidence varies geographically and racially. High-risk factors associated with ICP include maternal age, weight, obstetric history, and medical history. Clinical manifestations of ICP include pruritus, mild jaundice, and other symptoms, with potential for severe complications like stillbirth and preterm birth. There is no unified diagnostic criteria, but a fasting serum total bile acids (TBA) level ≥10 μmol/L or postprandial serum TBA ≥19 μmol/L is commonly used. Serum aminotransferase tests may complement the diagnosis. Severe ICP is characterized by elevated TBA levels, and early-onset ICP often occurs after 32 weeks of gestation. Maternal serum TBA monitoring is vital for disease management. Fetal monitoring is challenging, but fetal movements, electronic monitoring, and ultrasounds are recommended. Treatment with ursodeoxycholic acid and S-adenosyl-methionine aims to improve pruritus but lacks clear evidence for perinatal benefits. The timing of pregnancy termination depends on risk factors, and early delivery may be considered. Mode of delivery lacks specific guidelines. Postpartum follow-up is essential due to potential long-term health risks. Future research is needed to better understand and manage ICP.