Obstetric cholestasis in Hong Kong--local experience with eight consecutive cases.

Obstetric cholestasis is associated with maternal morbidity and adverse foetal outcomes. No information on local incidence is available. We present our experience with eight consecutive cases of obstetric cholestasis diagnosed between January 2003 and December 2005 in a regional hospital in Hong Kong. Three patients presented with pruritus without rash, three with impaired liver function, and two with elevated blood pressure postpartum. Meconium-stained liquor was present in five patients and four had spontaneous preterm delivery (between 34 and 36 weeks). The higher the bile acid level, the more marked the prematurity (correlation coefficient, -0.771; P=0.025). All those presenting with itchiness delivered preterm. Two patients developed pre-eclampsia. The rates of labour induction and abdominal delivery were both 38%. Heightened awareness among clinicians is required to recognise patients with obstetric cholestasis. Affected pregnancies are associated with meconium passage and prematurity. In our locality, affected women may also have an increased risk of pre-eclampsia. In affected women, the bile acid level is useful in assessing the risk of prematurity.

Successful treatment of recurrent, intractable hyperemesis gravidarum with methylprednisolone. A case report.

BACKGROUND: Severe and persistent hyperemesis gravidarum is a disabling condition. Women may request termination of pregnancy because of the intolerable symptoms and stress. CASE: A woman requested termination of pregnancy because of severe hyperemesis gravidarum. Her first three pregnancies were also complicated by severe and persistent vomiting. The vomiting was successfully treated with a short course of methylprednisolone. CONCLUSION: Methylprednisolone is an effective treatment for severe hyperemesis gravidarum and should be considered for women whose vomiting is persistent and refractory to conventional therapy.