Evaluation of Liver Disease in Pregnancy

Hepatic encephalopathy precipitated by preeclampsia in the setting of cirrhosis: A case report

“…This scenario presents diagnostic challenges that may lead to a missed/incorrect diagnosis, drastically altering management. While acute hepatic dysfunction in pregnant patients with preexisting liver disease should follow similar guidelines as the general population [ 3 , 4 , [10] , [11] , [12] ], the present case highlights the importance of considering hepatic dysfunction related to PESF, which prompted delivery (rather than expectant management), with rapid postpartum improvement. We provide a practical approach for differentiating the driver of acute hepatic dysfunction in patients with preeclampsia and cirrhosis.…”

“…Liver dysfunction complicates up to 3% of pregnancies, ranging from asymptomatic laboratory abnormalities to liver failure with significant maternal-fetal morbidity [ 1 , 2 ]. Liver disease in pregnancy can be categorized as pregnancy-related and/or coincidental to pregnancy (coincidental meaning either de novo during pregnancy or as an exacerbation of preexisting liver disease) [ [1] , [2] , [3] ]. The majority of liver dysfunction in pregnancy is pregnancy-related and includes: hyperemesis gravidarum, cholestasis of pregnancy, preeclampsia with severe features (PESF), hemolysis elevated liver enzymes low platelet (HELLP) syndrome, and acute fatty liver of pregnancy (AFLP) [ 1 , 2 , [4] , [22] , [23] ].…”