Liver disease in Pregnancy

8% of all pregnancies have low platelets. Get early expert help

Viral Hepatitis

• Seen in pregnancy and HAV and HEV can be more serious than non-pregnant
• Commonest cause of Jaundice in pregnancy
• Screen for HBV in those at risk to reduce vertical transmission

Acute fatty liver of pregnancy

• Seen in 3rd trimester. Commoner with primigravidas.
• RUQ pain. Progress rapidly to acute liver failure in days.
• Preeclampsia seen. Pancreatitis, hypoglycaemia.
• Medical/obstetric emergency. Liver unit and liver transplantation. Mortality rate high.
• PT/APTT/Fibrinogen abnormal Markedly elevated AST/ALT and Bilirubin

Intrahepatic cholestasis of pregnancy

• Itch and jaundice. Bilirubin x 9 normal. AST and ALT about 600 iu/L
• Common and seen in 2nd or 3rd trimester.
• Cholestatic effect of oestrogens in a genetically predisposed individual.
• Treat symptoms - cholestyramine and antihistamines.
• May recur with future pregnancies. If severe may require early delivery

Preeclampsia

• Hypertension, proteinuria and oedema
• 28 weeks - nausea, vomiting, hypertension, peripheral oedema
• Bilirubin normal. AST and ALT 1100 iu/L

HELLP syndrome (Haemolysis, elevated LFTs Low platelets)

• 3rd-trimester RUQ pain and Nausea, vomiting, hypertension
• Platelets < 80, AST ALT > 1100 iu/L. Bilirubin x 15 normal. Low haptoglobin
• AST > 1000 U/L. DIC may develop. Low platelets and haemolysis.
• Most serious result is liver infarction and haematoma or intraperitoneal bleeding requiring emergency surgery.
• Treatment is early delivery and if not reached 37 weeks gestation then steroids are given to promote fetal lung development
• PT/APTT/Fibrinogen normal initially prior to DIC