Pregnancy and liver disease

Serious liver disease in pregnancy is rare, although 3-5% of pregnancies will be complicated by abnormal liver tests. The differential diagnosis of abnormal liver tests in pregnancy is wide, encompassing the usual range of liver disorders as well as some that are unique to pregnancy. These heterogeneous diseases differ in etiology, symptomatology, laboratory findings, and outcomes. Hyperemesis gravidarum occurs in the first trimester and is characterized by intractable nausea and vomiting, leading to dehydration and electrolyte derangement. Intrahepatic cholestasis of pregnancy causes intense pruritus and can lead to fetal demise, although maternal outcomes are excellent; ursodeoxycholic acid improves pruritus and fetal outcome. The pre-eclampsia-associated liver diseases are pre-eclampsia/eclampsia and the hemolysis, elevated liver tests, and low platelet count (HELLP) syndrome; this can be life threatening to mother and fetus if complications occur. Immediate delivery is the only definitive therapy; corticosteroids are usually given to promote fetal lung maturity. Acute fatty liver of pregnancy is a sudden catastrophic illness of microvesicular fat accumulation in the liver that occurs in the third trimester; frank liver failure with coagulopathy and encephalopathy is imminent, prompting the need for rapid diagnosis and delivery.