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Cervical varices are a rare condition characterized by recurrent antepartum hemorrhage and less than 20 cases were reported in the literature. It is usually associated with placenta previa. We herein describe four cases of cervical varices without placenta previa. Meticulous speculum examination, ultrasonography with Doppler and colposcopy are essential for establishing the diagnosis and assessing the extent of the cervical varix. We propose to classify it as the apparent external os type or ultrasonography‐based endocervical type. Most cases presented in the literature were delivered by cesarean section. Nevertheless, one of our cases was a successful vaginal delivery. Our case illustrates that vaginal delivery is possible in isolated cervical varices. More case reports are needed to have a better understanding of this rare entity.

Background: Patient blood management plays an increasingly important role in the management of menorrhagia. We have used a dose-standardised protocol for intravenous (IV) iron therapy for menorrhagic patients, without complicated dose calculation or prolonged hospitalisation. This study aims to evaluate the efficacy, safety, and patient acceptability of IV iron therapy followed by oral iron supplement based on a dose-standardised protocol for menorrhagic patients with severe iron-deficiency anaemia. Methods: We retrospectively reviewed records of haemodynamically stable menorrhagic patients with severe irondeficiency anaemia (haemoglobin level, 6-8 g/dL) who were admitted to Kwong Wah Hospital between October 2017 and October 2018. The IV iron therapy involved two doses of 200 mg iron (ferric hydroxide sucrose complex, Venofer) followed by oral iron supplement for at least 4 weeks. Outcome measures included haemoglobin (Hb) and ferritin levels and total iron binding capacity before treatment and 4 weeks after the first dose, and resolution of anaemic symptoms. Results: Of 182 patients counselled with the option of IV iron therapy or blood transfusion, 138 (75.8%) opted for IV iron therapy. 24 of them were excluded. Of the 114 patients included, 52 (45.6%) had uterine fibroids, 23 (20.2%) had adenomyosis, and 39 (34.2%) had dysfunctional uterine bleeding. At 4 weeks after starting treatment, the mean Hb level increased significantly by 3.4 g/dL, the mean ferritin level increased significantly by 34.4 ng/mL, and the total iron binding capacity reduced significantly by 12.7 µmol/L. Before treatment, 103 (90.4%) patients reported anaemic symptoms. At 4 weeks after treatment started, anaemic symptoms had resolved in 102 (99.0%) patients. The increase in Hb level was not correlated with age, body weight, pre-treatment Hb level, or the interval between the two iron doses. One patient reported an adverse reaction with skin rash, which was treated with antihistamine. She had no anaphylaxis and her second dose was withheld. Conclusion: IV iron therapy based on a dose-standardised protocol followed by oral iron supplement is a costeffective, safe, well-accepted, and well-tolerated treatment for menorrhagic patients with severe iron-deficiency anaemia.

Background. Exposure to suboptimal intrauterine environment might induce structural and functional changes that can affect neonatal health. Telomere length as an important indicator of cellular health has been associated with increased risk for disease development. Objectives. This study was aimed to examine the independent and combined effects of maternal, obstetric, and foetal factors on cord blood telomere length (TL). Methods. Pregnant women at the gestational age of 20th to 24th week who attended the antenatal clinic of a major local hospital in Hong Kong were recruited. Participants were asked to complete a questionnaire on demographics, health-related quality of life, and history of risk behaviors. Medical history including pregnancy complications and neonatal outcomes was obtained from electronic medical records of both mother and neonate. Umbilical cord blood was collected at delivery for TL determination. Results. A total of 753 pregnant women (average age: 32.18 ± 4.51 years) were recruited. The prevalence of maternal infection, anaemia, and hypertension during pregnancy was 30.8%, 30.0%, and 6.0%, respectively. The adjusted regression model displayed that maternal infection was negatively associated with cord blood TL ( β = − 0.18 , p = 0.026 ). This association became even stronger in the presence of antenatal anaemia, hypertension, delivery complications, or neonatal jaundice ( β = − 0.25 to −0.45). Conclusions. This study consolidates evidence on the impact of adverse intrauterine environment at the cellular level. Maternal infection was significantly associated with shorter cord blood TL in a unique manner such that its presence may critically determine the susceptibility of telomere to other factors.

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