Liver disease in pregnancy

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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Chapter 23 LIVER DISEASE IN PREGNANCY

The most common liver diseases during pregnancy are preeclampsia and viral hepatitis. Less common causes that are specific to pregnancy include intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, Budd-Chiari syndrome, liver hematoma and rupture, and liver infarction.

In evaluating a patient with possible hepatic disease, liver cell damage is assessed by measurement of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), whereas hepatic synthetic function is assessed by measurement of albumin level and prothrombin time (PT). Cholestatic disease is assessed by measurement of levels of alkaline phosphatase and bilirubin.

Acute fatty liver of pregnancy usually occurs late in pregnancy and is a medical emergency. It often manifests with nausea and vomiting, abdominal pain, headache, jaundice, and altered mental status. Acute fatty liver of pregnancy is associated with ALT levels lower than 500 IU/L; in acute viral hepatitis, in comparison, levels are often higher than 1000 IU/L. In addition, acute fatty liver of pregnancy is associated with disseminated intravascular coagulation, renal failure, pancreatitis, and hypoglycemia.

Intrahepatic cholestasis of pregnancy usually manifests initially with pruritus, followed by the development of jaundice. It is associated with elevations in serum bile acids (at least three times the normal level), bilirubin (<5 mg/dL), cholesterol and triglyceride levels, and normal or mildly elevated transaminase levels.

Budd-Chiari syndrome is the occlusion of the hepatic venous system and usually occurs in women with an underlying thrombophilia. This syndrome can occur at any time in pregnancy, and patients usually present with abdominal pain and distension, which progresses to ascites.