a Case reportA 39 year old woman came to the antenatal clinic for booking at the 12 th week of her ®fth pregnancy. She complained of pruritis, particularly over her hands and feet. The pruritis preceded her pregnancy by ®ve months. There was no change in urine or stool colour and her appetite was good. Physical examination showed no abnormality. She had no rash, took no medication, and there was no family history of liver disease. She drank less than 15 units of alcohol per week before her pregnancy and had then become abstinent.She had four previous pregnancies, the ®rst pregnancy being complicated by pre-eclampsia at term, the second and third ending in miscarriages in the ®rst trimester, and the fourth being an uneventful full term pregnancy. Five years previously she had attended her general practitioner with tiredness, nausea, headache, reduced appetite and her stool looking`different'. Liver function tests revealed an elevated gamma-glutamyl transferase level at 112 iu/L. Ultrasound examination of her liver was normal. Liver function tests repeated one week later showed no change. As her symptoms had improved by the second consultation, no follow up was thought necessary. Her past medical history included infection with hepatitis A virus, and depression after her second miscarriage.