![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
|
During pregnancy, there are significant normal physiologic changes in liver function studies. These include:
However, there are also certain liver conditions that may cause complications in pregnancy. These include: Hepatitis The most common liver disease encountered during pregnancy is that of hepatitis. This is no different than in the non-pregnant individual. In some areas around the world such as India, it remains the most common cause of maternal death during pregnancy. It has also been appreciated that the finding of a mother who is a carrier for hepatitis places her foetus at risk in later life of developing both chronic hepatitis and cancer of the liver . It has become accepted clinical practice to screen all patients with a hepatitis surface antigen as a part of their regular prenatal laboratory work. The diagnosis, evaluation and treatment of hepatitis during pregnancy is no different than in a non-pregnant individual. Cholestatis of pregnancy Cholestatis of pregnancy is a condition of unknown cause.
It usually arises late in the third trimester of pregnancy. The primary
symptom associated with it is extreme itchiness. There may also be mild
jaundice (yellowing of the skin due to excess bilirubin). The laboratory
evaluation in such patients reveals a tremendous increase in alkaline
phosphatase to 7-10 times above normal. If the serum bile acids were assayed,
it would be found that they are between 10 and 100 times normal. It is
this extreme elevation of bile acids which is felt to cause the generalised
pruritis. Liver biopsies which have been performed in such patients show
simple biliary status without disruption of the hepatocellular architecture.
Acute Fatty Liver of Pregnancy A more serious liver disease encountered during pregnancy is that of acute fatty liver. This, too, is a condition of unknown cause. It is an extremely rare condition affecting less than 1 in 10,000 patients. The symptoms are that of a rather sudden onset in the last four weeks of pregnancy of rapidly deepening jaundice, somnolence, and in short order, coma, bleeding dyathosis, and hepatorenal failure. The usual time course from onset of symptoms to hepatorenal failure is approximately 2 weeks. The maternal mortality rate from acute fatty liver of pregnancy approaches 30%. Some similarities to this condition with Reye's syndrome have been suggested. However, there is enough variation in the symptoms and the pathology that such an association is suspect. The diagnosis of acute fatty liver of pregnancy is usually made upon liver biopsy. The biopsy shows an intense infiltration of all the hepatocytes by fat with a marked disruption of the hepatic architecture. The liver transaminase will be markedly elevated. The alkaline phosphatase will be slightly elevated. The bilirubin is significantly elevated. It has been recognised as of late that the rapid delivery of the baby will improve the maternal mortality. It has been this understanding which has lead to the improvement in the survival rates from such a condition. There is one case in the literature where, despite the delivery of the baby, it was felt that the disease process had not been reversed and the patient underwent successful liver transplant. There are several cases reported where patients who have survived acute fatty liver of pregnancy have subsequently had an uneventful pregnancy. It has been suggested that there is no increased risk of recurrence. However, the number of such patients is small and it seems premature to advise the margin of safety in subsequent pregnancies.
The information in this page is presented in summarised form and has been taken
from the following source(s):
|
|
![]() |
![]() |
![]() |
![]() |
|
http://www.hon.ch/Dossier/MotherChild/preexisting_conditions/liver.html | Last modified: Jun 25 2002 |