The liver in pregnancy

Chapter 21 The liver in pregnancy




Key Points










TABLE 21.1 Changes in liver biochemical test levels in normal pregnancy











































Test Change Trimester of maximum change
Albumin ↓ 10%–60% Second
Gamma globulins None to slight ↓ Third
Fibrinogen ↓ 50% Second
Transferrin Third
Bilirubin None
Alkaline phosphatase ↓ Two- to fourfold Third
AST None
ALT None
Cholesterol ↓ Twofold Third

↓, increase; ↓, decrease; ALT, alanine aminotransferase; AST, aspartate aminotransferase.


From Olans LB, Wolf JL. Liver disease in pregnancy. In: Carlson KJ, Eisenstat SA, eds. The Primary Care of Women, 2nd edn. St. Louis: Mosby–Year Book; 2003:531–539.




Approach to the Pregnant Patient



History











TABLE 21.2 Differential diagnosis of elevated serum aminotransferase levels and/or jaundice according to trimester of pregnancy






















































Trimester Differential diagnosis
First Hyperemesis gravidarum
  Gallstones
  Viral hepatitis
  Drug-induced hepatitis
  Intrahepatic cholestasis of pregnancy
Second Intrahepatic cholestasis of pregnancy
  Gallstones
  Viral hepatitis
  Drug-induced hepatitis
  Pre-eclampsia/eclampsia
  HELLP syndrome
Third Intrahepatic cholestasis of pregnancy
  Pre-eclampsia/eclampsia
  HELLP syndrome
  Acute fatty liver of pregnancy
 




HELLP, hemolysis, elevated liver tests, low platelets.


Uncommon in this trimester.


From Olans LB, Wolf J. Liver disease in pregnancy. In: Carlson KJ, Eisenstat SA, eds. The Primary Care of Women, 2nd edn. St. Louis: Mosby–Year Book; 2003:531–539.


TABLE 21.3 Rates of recurrence of pregnancy-associated liver disease in subsequent pregnancies


















Disease Rate of recurrence
Intrahepatic cholestasis of pregnancy 40%–70%
HELLP syndrome 4%–27%
Acute fatty liver of pregnancy 20%–70% in carriers of LCHAD mutation
Pre-eclampsia 2%–43%

HELLP, hemolysis, elevated liver tests, low platelets; LCHAD, long-chain 3-hydroxyacyl-coenzyme A dehydrogenase.




Diagnostic tests















Liver Disorders Unique to Pregnancy


See Table 21.4 for the laboratory findings associated with these disorders.





Intrahepatic cholestasis of pregnancy








Jun 4, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on The liver in pregnancy
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