Abstract
Obstetric cholestasis (OC) presents mainly in the third trimester and uncommonly in the second trimester of pregnancy. It is characterised by pruritus, abnormal liver enzymes and raised total serum bile acids (TSBA). Cholestasis resolves after delivery. OC presenting in first trimester is rare, therefore the management guidelines are unclear. The present case is being reported as a case of first trimester OC, unresponsive to common treatment modalities. The patient was diagnosed with OC at 12 weeks. She didn't respond to the therapeutic doses of ursodeoxycholic acid (UDCA) and cholestyramine. Finally, rifampicin was added, which gave clinical relief, improved liver enzyme levels and allowed the pregnancy to continue till 32 weeks.
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