Cardiotocography (CTG) and serum total bile acid level were used in the perinatal surveillance of 117 pregnancies with intrahepatic cholestasis. Signs of fetal distress occurred more commonly in cholestasis pregnancies with high maternal bile acid levels. Despite careful monitoring one intrauterine fetal loss occurred without any warning signs in CTG. In this case the serum bile acid level was only moderately elevated. CTG seems to be suitable for detection of fetal distress in cholestasis pregnancies. Those with high maternal bile acid level should be subjected to a more intensive follow-up. Some fetal risk, however, seems to remain despite of the use of these methods.