Treatment with ursodeoxycholic acid (UCDA) did not reduce perinatal outcomes in women with intrahepatic cholestasis of pregnancy, according to results in a new large, placebo-controlled randomized trial (PITCHES). 605 women were enrolled in the study from across 33 hospital maternity units in England and Wales and were randomly allocated to receive either UCDA (n = 305) or placebo (n = 300). The primary outcome, which included perinatal death, preterm delivery or neonatal unit admission for at least 4 h, was similar between the two treatment groups, 23% in the UCDA group versus 27% in the placebo group (adjusted risk ratio of 0.85; 95% CI 0.62–1.15). As UCDA does not seem to have any substantial clinical benefit in intrahepatic cholestasis of pregnancy, the authors recommend reconsidering the routine use of UCDA for this condition.