Background: Different spectrum of liver disease can affect outcome of pregnancy. The incidence of liver disorders in pregnancy varies in different parts of the world. The present study was designed to see the incidence, spectrum, and outcome of liver disease in pregnancy.Methods: All pregnant women with deranged liver profile, attending antenatal clinic and labour room in the department of Obstetrics and Gynecology of BRD Medical College over the period of one year (August 2015 to July 2016) were included in the study. Enrolled cases were followed up till discharge in respect to maternal and fetal outcome.Results: Liver disease was found in 214 (2.37%) cases out of 9011 pregnancies. Pregnancy specific liver disease was the most common type (85.98%). Among pregnancy specific liver disease Hypertensive disorders of pregnancy was the commonest abnormality (66.35%). Rest were Cholestasis, Acute viral hepatitis, Chronic liver disease, Hyperemesis gravidarum, Acute fatty liver of pregnancy. Out of 214, 22 patients dropped out. Overall maternal and perinatal mortality were 13.02% and 29.17% respectively.Conclusions: Liver disease in pregnancy is not uncommon and it can seriously affect pregnancy outcome if not treated properly on time. Early diagnosis (by clinical suspicion and blood investigation) and timely intervention can improve maternal and fetal outcome in pregnancy with liver disease.

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P-aHUS has incidence of 1 in 25000 pregnancies. It's characterized by microangiopathic haemolytic anemia, thrombocytopenia and renal failure. Mrs X, 26 year old lady, G2 P1L1 with 39 weeks POG came to emergency of a tertiary care hospital. She underwent LSCS in view of previous caesarean section not willing for trial of labour. Antenatal, intrapartum and immediate post operative period were uneventful. However, she became anuric 36 hours post operatively. Laboratory investigations suggested hemolysis. Complement system evaluation showed decreased complement levels. Diagnosis of p-aHUS was made by taking multidisciplinary approach and renal biopsy. Patient received 4 sessions of plasmapheresis and symptomatic treatment. Gradually her urine output increased and she was discharged with the baby on post operative day 19. Diagnosis of p-aHUS is tricky owing to similar clinical features with many other pregnancy associated conditions. Timely management and diagnosis are imperative to save the mother's life.