Approach to liver disease occurring during pregnancy
- Richard H Lee, MD
Richard H Lee, MD
- Assistant Professor of Clinical Obstetrics and Gynecology
- Division of Maternal Fetal Medicine
- Keck School of Medicine of the University of Southern California
- Tram T Tran, MD
Tram T Tran, MD
- Medical Director of Liver Transplantation
- Liver Disease and Transplant Center at Cedars-Sinai.
- Section Editors
- Keith D Lindor, MD
Keith D Lindor, MD
- Section Editor — Alcoholic and Metabolic Liver Disease
- Professor of Medicine, Mayo Clinic College of Medicine
- Dean, College of Health Solutions
- Arizona State University
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deputy Editors
- Anne C Travis, MD, MSc, FACG, AGAF
Anne C Travis, MD, MSc, FACG, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Hepatobiliary disease occurring in a pregnant woman poses a challenge for the consulting clinician. Hepatic abnormalities occurring during pregnancy require diagnosis in the context of expected physiologic changes. In addition, diagnostic and therapeutic decisions have to consider the implications for both the mother and the fetus.
The types and presentation of hepatobiliary disease during pregnancy are varied.
●Some liver diseases or multisystem diseases with hepatic manifestations are specific to pregnancy. Examples of the former are intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy; examples of the latter are hyperemesis gravidarum and preeclampsia, which may be complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). (See appropriate topic reviews).
●Pregnancy-related physiologic changes may worsen the severity of, or predispose to hepatobiliary diseases that may also occur in nonpregnant women. Examples include cholelithiasis, thrombotic diseases (such as Budd-Chiari syndrome), and hepatitis E virus infection. (See "Intercurrent hepatobiliary disease during pregnancy".)
●Some diseases are not related to pregnancy but can initially present during pregnancy (eg, acute viral hepatitis). (See "Intercurrent hepatobiliary disease during pregnancy".)
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- THE LIVER DURING NORMAL PREGNANCY
- Physical examination
- Ultrasound examination
- Serum proteins and lipids
- Liver tests
- PREVALENCE OF HEPATOBILIARY DISEASE IN PREGNANCY
- APPROACH TO DIFFERENTIAL DIAGNOSIS
- ROLE OF A LIVER BIOPSY
- Clinical scenarios
- - A patient with elevated aminotransferases
- - A patient with intractable itching
- - A patient with elevated aminotransferases and hypertension
- - A patient with nausea and vomiting in the third trimester
- MATERNAL MORTALITY
- RECURRENCE IN SUBSEQUENT PREGNANCIES
- SUMMARY AND RECOMMENDATIONS