Background: the aim of the current study was to examine the relationship between levels of serum bile acid and occurrence of the obstetric cholestasis and to determine the association of obstetric cholestasis with fetal outcomes, including preterm birth, fetal distress, and stillbirth. Study design: A cross-Sectional Study Place and duration of study : department of Obstetrics and Gynaecology in HMC Peshawar from April 2023 to April 2024 Methods: The current study adopted retrospective cross-sectional research design. As per inclusion criteria, those pregnant women, visiting HMC Peshawar, were included who undergone serum bile acid levels tests during their pregnancies. A sample of 152 was considered. Data for Serum Bile Acid Levels was Retrieved from laboratory results documented in the medical records, data for Obstetric Cholestasis Diagnosis was Identified based on documented clinical diagnoses, while Preterm Birth < 37 weeks of gestation, Fetal Distress as documented in medical records and stillbirth as fetal death after 20 weeks of gestation was considered for fetal outcomes. All the analysis, i.e., demographic, descriptive, correlation and Anova was conducted through SPSS. Results: The study found a significant link between elevated serum bile acid levels and obstetric cholestasis, with a moderate to strong correlation (r = 0.68, p < 0.001). Obstetric cholestasis was also notably associated with adverse fetal outcomes, including preterm birth (47.2%), fetal distress (34.0%), and stillbirth (11.3%). Conclusion: The study concluded that that routine monitoring of serum bile acid levels be implemented for early detection of obstetric cholestasis. Healthcare providers should integrate bile acid level assessments into prenatal care to prevent adverse outcomes