An increase of liver function scores may be related to rarely diagnosed drug-induced liver injuries. Their frequency of pregnant women is increasing against the background of therapy of miscarriage with gestagens, which have potential heptotoxicity. The clinical case with the progression of acute hepatitis caused by the use of dydrogesterone and micronized progesterone was analyzed according to the criteria of the European Association for the Study of the Liver and the RUCAM scale, taking into account the physiological growth of alkaline phosphatase activity during gestation. The probability of drug damage to the liver, risk factors, variant, severity were determined. Typical mistakes in diagnosis and treatment are shown, recommendations are given on the use of hepatoprotectors in women with this pathology. An opinion about the genetic relationship of gestagen-induced liver damage and intrahepatic cholestasis of pregnancy and the need to create clinical guidelines for the management of pregnant women with drug-induced liver injuries was expressed

The article shows the main causes of functional and organic abdominal pain and its specific types during pregnancy. The author presents the tactics of patient management, the peculiarities of the interpretation of laboratory data in case of suspected acute surgical pathology and “alarm symptoms” in case of abdominal pain in pregnant women. She emphasized the importance of imaging techniques in the differential diagnosis of acute abdomen syndrome in the gestational period. Article also substantiates safety and the need for magnetic resonance imaging in patients with persistent abdominal pain. It discusses a clinical case of paralytic intestinal obstruction in a pregnant woman. It analyzes the drug therapy for abdominal pain, taking into account the prevalence of the expected benefit to the mother over the potential risk to the fetus. The author demonstrates that the management of abdominal pain relies on a conservative approach due to the lack of evidence base on the safety of drugs for the fetus and clinical guidelines for the management of pregnant women with abdominal pathology. Author also emphasizes the need for legal registration of the appointment of magnetic resonance imaging and computed tomography, as well as off-label pharmacotherapy the instructions during gestation.

The growth of liver tests in the second half of pregnancy is most often caused by two reasons - Intrahepatic Cholestasis of pregnancy (ICP) and rarely diagnosed Drug-Induced Liver Injuries (DILI). In Assisted Reproductive Technology (ART)-induced pregnancies that are accompanied by powerful drug support, the incidence of drug-induced cholestasis increases. This is due to the combined use of gestagens and other drugs that have hepatotoxic potential for the prevention of miscarriage. The article reveals the risks of IVF, which is often performed for women in late reproductive age, accompanied by multiple pregnancies, somatic pathology, thrombophilia and forced polypharmacy. The article presents an analysis of the clinical observation of a pregnant woman as a result of IVF, who developed acute drug hepatitis against the background of polypharmacy, and its examination according to the criteria of the European Association for the Study of the Liver (EASL) and the RUCAM algorithm. The author believes that the limitation of the RUCAM scale is manifested by insufficient consideration of the effect of pregnancy and polypharmacy on the development of DILI. According to the author, it is necessary to differentiate the DILI from ICP in connection with the peculiarities in the management tactics, despite their probable genetic affinity and clinical and laboratory similarities. The author suggests that DILI during pregnancy is a reservoir for the subsequent development of chronic diffuse liver diseases in women. In this regard, such patients need the observation of a therapist for 6-12 months after childbirth.

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