Intrahepatic cholestasis of pregnancy (ICP) is the most prevalent pregnancy-specific hepatobiliary disorder. It typically presents in the third trimester with pruritus and is biochemically characterized by elevated total bile acid (TBA) and/or alanine aminotransferase (ALT) levels. Clinical and laboratory abnormalities resolve rapidly postpartum; however, recurrence in subsequent pregnancies is common. ICP is associated with increased risks of adverse perinatal outcomes, notably spontaneous preterm birth, fetal respiratory distress, and unexplained stillbirth. Elevated concentrations of pregnancy-related hormones and genetic susceptibility are key etiological factors. In affected women, pruritus accompanied by increased TBA and transaminase levels warrants close monitoring throughout gestation. Management focuses on alleviating maternal symptoms, normalizing biochemical markers, and minimizing fetal risks. Ursodeoxycholic acid remains the first-line pharmacological intervention, effectively reducing TBA concentrations and potentially improving pruritus. In cases unresponsive to medical therapy, consideration should be given to iatrogenic preterm delivery.