Liver diseases in pregnancy

Lim, Elvyna; Mouyis, Maria; Mackillop, Lucy

doi:10.7861/clinmed.2021-0497

Cited by 16 publications

(22 citation statements)

References 27 publications

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“…Liver dysfunction is not uncommon during pregnancy, especially in subjects with risk factors such as twin pregnancy, obesity and previous liver disease [ 1 , 2 ]. The most common causes of liver dysfunction are pregnant-related liver diseases, such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy (ICP), gestational hypertension (GH), pre-eclampsia (PE) and HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome [ 1 , 2 , 3 , 4 ]. Other causes may be an exacerbation of an already present liver disease or new onset of liver disease not specific to pregnancy, such as viral hepatitis, autoimmune liver disease, metabolic dysfunction-associated liver disease etc.…”

Section: Introductionmentioning

confidence: 99%

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

Serra

Dajti

Molo

et al. 2023

JCM

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Grayscale abdomen ultrasound (US) is routinely performed in pregnant women with suspected pregnancy-related liver dysfunction, but its diagnostic yield is very low. We aimed to investigate the association between Doppler-US findings, liver stiffness measurement (LSM) and different causes of pregnancy-related liver dysfunction. This is a prospective cohort study of pregnant women referred to our tertiary center for any suspected gastrointestinal disease between 2017 and 2019 and undergoing Doppler-US and liver elastography. Patients with previous liver disease were excluded from the analysis. For group comparisons of categorical and continuous variables, the chi-square test or Mann–Whitney test, and the McNemar test were used, as appropriate. A total of 112 patients were included in the final analysis, of whom 41 (36.6%) presented with suspected liver disease: 23 intrahepatic cholestasis of pregnancy (ICP), six with gestational hypertensive disorders and 12 cases with undetermined causes of elevated liver enzymes. Values of LSM were higher and significantly associated with a diagnosis of gestational hypertensive disorder (AUROC = 0.815). No significant differences at Doppler-US or LSM were found between ICP patients and controls. Patients with undetermined causes of hypertransaminasemia showed higher hepatic and splenic resistive indexes than controls, suggesting splanchnic congestion. The evaluation of Doppler-US and liver elastography is clinically useful in patients with suspected liver dysfunction during pregnancy. Liver stiffness represents a promising non-invasive tool for the assessment of patients with gestational hypertensive disorders.

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Section: Introductionmentioning

confidence: 99%

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

Serra

Dajti

Molo

et al. 2023

JCM

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“…The characteristics of pregnancy-related liver diseases are summarized in Table 2. 1,18,19 Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that results in weight loss of more than 5% of body weight, dehydration, ketonuria, and electrolyte abnormalities. The prevalence of hyperemesis gravidarum is 0.3% to 3% of pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Jaundice Caused by Hyperemesis Gravidarum

Pornchai

Kamalaporn

Sriphrapradang

2022

TOJ

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Background: Hyperemesis gravidarum is characterized by intractable vomiting and associated with weight loss exceeding 5% of prepregnancy body weight, dehydration, and ketosis. Hyperemesis gravidarum occurs during the first trimester and typically resolves by 16 to 20 weeks of gestation. Approximately half of all hospitalized females with hyperemesis gravidarum have a mild elevation in liver enzymes; however, jaundice and hepatic synthetic dysfunction are uncommon. Case Report: A 22-year-old gravida 1 para 0 in her ninth week with a singleton gestation was hospitalized with persistent nausea, vomiting, weight loss of 11% of her prepregnancy body weight, dehydration, hypokalemia, and jaundice. Liver function tests showed hyperbilirubinemia of 7.1 mg/dL and alanine aminotransferase levels high as 676 U/L. Other hepatobiliary diseases were excluded. Thyroid function tests revealed thyrotoxicosis. Gestational thyrotoxicosis is often associated with hyperemesis gravidarum because of their shared pathophysiology of high human chorionic gonadotropin levels during the first trimester. After supportive management including hydration, correction of electrolyte disturbance, vitamin supplementation, and antiemetic treatment, the patient's symptoms resolved. Liver and thyroid dysfunction returned to normal after resolution of vomiting. The patient delivered a healthy child at 38 weeks' gestation. Conclusion: Elevation of aminotransferase and bilirubin levels may occur in patients with hyperemesis gravidarum. Although jaundice and highly elevated liver enzymes have been reported, investigations to exclude preexisting and concurrent liver diseases are required. Management of hyperemesis gravidarum is supportive, and outcomes are generally favorable.

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“…Severe hypertension requiring treatment with intravenous antihypertensive agents. Eclampsia [ 25 ] Severe preeclampsia characterized by sudden onset of generalized tonic-clonic seizures Severe postpartum haemorrhage [ 14 , 26 ] Documented estimated blood loss ≥ 2000 ml, need for blood transfusion of at least 3 U, or hysterectomy, with or without radiological embolization of uterine arteries Suspected sepsis [ 19 ] Clinically suspected focus of infection ± positive laboratory culture, treated with antibiotics (excluding commensals and antibiotic prophylaxis) Shock [ 18 ] Persistent severe hypotension defined as systolic blood pressure < 90 mmHg for 60 min or decreased by 40 mmHg with increased pulse rate Pulmonary oedema [ 19 ] Breathlessness, crepitations requiring diuretics Thromboembolism [ 12 ] CTPA confirmed pulmonary embolism, venous thrombosis in the pelvic region, deep venous thrombosis in the extremities or sinus thrombosis Diabetic ketoacidosis [ 19 ] Hyperglycaemia, metabolic acidosis, ketones in urine Intracranial tumour [ 19 ] CT ⁄ MRI confirmed Status epilepticus [ 19 ] History of epilepsy, prolonged multiple seizures Other serious medical conditions [ 19 , 27 – 29 ] Acute pancreatitis, liver failure, acute fatty liver of pregnancy, acute appendicitis or other critical illness SBP Systolic blood pressure, DBP Diastolic blood pressure, AST Aspartate aminotransferase, Cr Creatinine, CrCL Creatinine clearance, CTPA Computed tomography pulmonary angiogram, MRI Magnetic resonance imaging …”

Section: Methodsmentioning

confidence: 99%

A new modified obstetric early warning score for prognostication of severe maternal morbidity

Zhu

Song

et al. 2022

BMC Pregnancy Childbirth

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Background Maternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU). Methods A retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Results A total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P < 0.001]. MOEWSs of 24 h after ICU admission had higher sensitivity, specificity and AUROC than MOEWSs of 24 h before ICU admission. When combining the two MOEWSs, sensitivity of MOEWS was 99.3% (95% CI: 98–100), specificity 75.8% (95% CI: 63–86), positive predictive value (PPV) 95.1% (95% CI: 92–97) and negative predictive value (NPV) 95.9% (95% CI: 86–100). The areas under the receiver operator characteristic (ROC) curves of MOEWS were 0.92 (95% CI: 0.88–0.96) and 0.70 (95% CI: 0.63–0.76) of the APACHE II score. Conclusion The newly proposed MOEWS has an excellent ability to identify critically ill women early and is more effective than APACHE II. It will be a valuable tool for discriminating severe maternal morbidity and ultimately improve maternal health.

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Liver diseases in pregnancy

Cited by 16 publications

References 27 publications

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

Jaundice Caused by Hyperemesis Gravidarum

A new modified obstetric early warning score for prognostication of severe maternal morbidity

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