Liver disease in pregnancy

Chapter 23 LIVER DISEASE IN PREGNANCY



Kathleen Dor


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.



Medications Associated with Liver Disease




Angiotensin-converting enzyme (ACE) inhibitors


Acetaminophen


β blockers


Calcium channel blockers


Isoniazid


Ketoconazole


Methyldopa


Minocycline


Nitrofurantoin


Phenytoin


Pyrazinamide


Sulfonamides


Terbinafine



Causes of Liver Disease in Pregnancy




Acute fatty liver of pregnancy


Alcoholic hepatitis


Autoimmune hepatitis


Budd-Chiari syndrome


Cirrhosis


Eclampsia


Gallbladder disease


Syndrome of hemolysis, elevated liver enzyme counts, and low platelet count (HELLP)


Hyperemesis gravidarum


Intrahepatic cholestasis of pregnancy

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Jun 4, 2016 | Posted by in GYNECOLOGY | Comments Off on Liver disease in pregnancy

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