In cholestatic liver disease, pruritus, jaundice, or both are the main features of the presentation, but there is no abdominal pain. Included in this group of diseases are hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, hepatotoxic effects of drugs, and primary biliary cirrhosis. Although rare, the Dubin–Johnson syndrome (caused by an inherited defect in the hepatic excretion of organic anions, including conjugated bilirubin) may be exacerbated by pregnancy and marked by the development of jaundice during the second or third trimester. It is a benign condition, without pruritus, and is characterized by mild conjugated hyperbilirubinemia with otherwise normal liver-enzyme values.13 Biliary tract disease, caused by gallstones, may occur at any time during pregnancy and is accompanied by pain in the right upper quadrant and fever. Jaundice may occur when the common bile duct is obstructed by a stone. Endoscopic retrograde cholangiopancreatography with papillotomy relieves obstruction of the common bile duct and can be performed by an experienced practitioner safely and with minimal radiation to the fetus.