Pregnancy-Related Liver Disorders

Abstract

Pregnancy-related liver disorders accounted for 8% of all maternal deaths at our center from 1999 to 2011. Of the three pregnancy-related liver disorders (acute fatty liver of pregnancy (AFLP), HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclamptic liver dysfunction, which can lead to adverse maternal and fetal outcome, AFLP is most typically under -diagnosed. Risk of maternal death can be minimised by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these life threatening disorders, but recent advancements in our understanding help us in better overall management of these patients. This review focuses on various aspects of pregnancy-related liver disorders. ( J CLIN EXP HEPATOL 2014;4:151-162) A ny liver disorder can occur co-incidentally in pregnancy. Pregnancy can also occur in a patient with pre-existent chronic liver disorder/portal hypertension. In addition, liver dysfunction in pregnancy can also be secondary to pregnancy (i.e. pregnancy-related liver disorders). The 5 pregnancy-related liver disorders-acute fatty liver of pregnancy (AFLP), HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), pre-eclamptic liver dysfunction, intrahepatic cholestasis of pregnancy (ICP) and hyperemesis gravidarum-occur in different gestational time periods.

Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

“…Maternal outcomes were generally positive, as indicated in many previous reports. [2][3][4][5] 76.7% of patients had vaginal deliveries while the rest (23.3%) underwent cesarean delivery.…”

“…The differential diagnosis includes viral or autoimmune hepatitis, primary biliary cirrhosis, and cholelithiasis. [2][3][4][5] The pathogenesis of ICP remains poorly understood: inflammatory, immunological and genetic influences contribute, as does pre-existing hepatobiliary disease. [6][7][8] ICP may be a challenge for health care providers because of the potential of severe fetal consequences, including prematurity and stillbirth.…”

Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

“…It has been reported that Pregnancy-related liver disorders accounted for 8% of all maternal deaths at one center from 1999 to 2011. 109 Risk of maternal death can be minimized by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these lifethreatening disorders, but recent advancements in our understanding help us in better overall management of these patients.…”

An uncommon case of acute fatty liver of Pregnancy

“…[1] It carries a significant perinatal and maternal mortality. [2] It usually presents between 30th and 38th weeks of gestation, though reports of rare presentation in second trimester are also there. [3] It presents more frequently in primipara than multiparous women but can occur after multiple uneventful pregnancies and in subsequent pregnancies too.…”