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Objective To investigate the relationship between serum bile acid and fetal distress in patients with intrahepatic cholestasis of pregnancy. Methods The clinical data of 120 patients with intrahepatic cholestasis of pregnancy were retrospectively analyzed during January 2007 to October 2013. Patients were divided into mild and severe groups according to serum bile acid value. The information of delivery mode and the incidence of fetal distress were collected. Results There was no statistically significant difference in age of patients between the two groups. The caesarean section rate and incidence of fatal distress in severe group was significantly higher than those of mild patients. Conclusion In the late pregnancy of patients with intrahepatic cholestasis of pregnancy requires close monitoring of serum bile acid value. High-risk patients should be prepared to grasp the opportunity to terminate the pregnancy to ensure maternal and child health. [ABSTRACT FROM AUTHOR]