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