Ursodeoxycholic acid ( UDCA) .
UDCA 500 mg twice a day, can be increased by 250 to 500 mg / week till 2 gram per day if there is no improvement in symptoms. ( Source- Intrahepatic cholestasis of pregnancy, TOG 2016)
Ursodeoxycholic acid (UDCA) improves pruritus and liver function in women with obstetric cholestasis.
Women should be informed of the lack of robust data concerning protection against stillbirth and safety to the fetus or neonate.

Correct answer is- Rifampicin, Antihistaminics, and aqueous creams.

Cholestyramine may improve maternal morbidity, but has not been shown to be as effective as UDCA. Also , by interfering with absorption of vitamin K, it may lead to impaired coagulation ( Increasing the risk of fetal intracranial haemorrhage) . Therefore it is not used in Obstetric Cholestasis.

Rifampicin- In a study in 2015, Rifampicin was found to reduce bile acid levels in Obstetric Cholestasis. It has been used with UDCA in the management of Primary Biliary Cirrhosis.( This appeared an MRCOG Exam question)

S adenosyl Methionine-There is insufficient evidence to demonstrate whether S-adenosylmethionine (SAMe) is effective for either control of maternal symptoms or for improving fetal outcome, and it is not recommended. Its administration as a twice-daily and usually intravenous infusion makes SAMe use unacceptable.

Dexamethsone has not been found to be useful. ( There is conflicting evidence of effectiveness and there is concern over fetal neurological effects) .
Antihistaminics and topical treatments have been found useful in symptomatic treatment. Chlorphenramine mainly provides sedation, but less relief from pruritus.
Activated charcoal and guargum have not been found to be useful .
Source- TOG 2016, Intrahepatic cholestasis of pregnancy
GTG 43