Obstetric cholestasis in Hong Kong—local experience with eight consecutive cases

TK Lo, WL Lau, Helena SW Lam, WC Leung, Robert KH Chin
Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong

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.

Hong Kong Med J 2007;13:387-91

Key words: Bile acids and salts; Cholestasis, intrahepatic; Infant, premature; Meconium; Pre-eclampsia