A randomised controlled trial of ursodeoxycholic acid and S-adenosyl-l-methionine in the treatment of gestational cholestasis.

Objective: To compare the efficacy of S-adenosyl-l-methionine and ursodeoxycholic acid in improving serum biochemical abnormalities in gestational cholestasis.

Design: Randomised clinical trial.

Setting: University hospital.

Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term.

Objective: We have investigated the use of uterine artery Doppler waveform analysis in growth restricted fetuses delivered at > or =34 weeks.

Study Design: Included in the study were all consecutive euploid non-malformed singleton fetuses with accurate dating diagnosed as growth restricted (sonographic abdominal circumference <10th percentile) between January 1995 and December 1998 and who were delivered at > or =34 weeks. Delivery was expedited for biophysical profile 6 or less with nonreactive nonstress test, preeclampsia, oligohydramnios, absent fetal growth over 2 weeks, absent or reversed diastolic flow in the umbilical artery (UA), or UA pulsatility index (PI) greater than the 95th percentile after 37 weeks.

Obstetric cholestasis: outcome with active management.

Objective: Conservative management of intrahepatic obstetric cholestasis is associated with a high stillbirth rate despite monitoring of fetal well-being with non-stress test and amniotic fluid volume assessment. Most cases of stillbirth are associated with meconium passage. We prospectively evaluated the effect of a management protocol inclusive of surveillance for presence of meconium and induction of labor at 37 weeks.