Prospective study of liver dysfunction in pregnancy in Southwest Wales

Abstract

Background: Liver dysfunction in pregnancy has serious consequences. Its frequency and characteristics have not been systematically documented in Britain. We have prospectively determined incidence, causes, and outcome of liver dysfunction in pregnancy in an obstetric unit in Southwest Wales, UK. Methods: A central laboratory identified all abnormal liver tests (bilirubin >25 µmol/l, aspartate transaminase >40 U/l, or γ glutamyl transpeptidase >35 U/l) from patients in antenatal clinics and wards of an obstetric unit serving a population of 250 000. Patients with abnormal liver tests were assessed and followed through after pregnancy. Medical advice was provided to obstetric teams. Findings: There were 4377 deliveries during the 15 month study. A total of 142 patients had abnormal liver tests. There were 206 contributing diagnoses, the great majority being pregnancy specific. Among the most important were pre-eclampsia (68), HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome (30), obstetric cholestasis (23), hyperemesis gravidarum (11), acute fatty liver of pregnancy (five), and hepatic infarct (one). Sepsis, postoperative factors, and placental pathology (51) were not uncommonly responsible but incidental or pre-existing hepatobiliary disease was infrequent (17). Sixty five patients were delivered early by induction or caesarean section because of liver dysfunction. Despite substantial liver related morbidity, there were no maternal deaths and only two intrauterine deaths. Conclusions: Liver dysfunction was seen in 3% of deliveries during a 15 month prospective study and was usually directly related to pregnancy with spontaneous recovery in the puerperium. Incidence of the most serious conditions, acute fatty liver of pregnancy and HELLP syndrome, was much greater than previously reported. Profound effects on maternal and infant health were observed but close medical and obstetric collaboration ensured low mortality.

ACG Clinical Guideline: Liver Disease and Pregnancy

“…Hepatic failure can manifest with signs of hepatic dysfunction such as encephalopathy, coagulopathy, and hypoglycemia. Renal dysfunction and pancreatitis are common ( 72 ).…”

Jaundice and Pregnancy: Why Going Viral Is Out of Style

“…While the authors identify gallstone-related disease as the most common cause of hyperbilirubinemia, the preponderance of a Hispanic population in this study raises the question of whether these findings would apply to a broader-based US population. Pregnancy-related disease, the second most common etiology in the current study, is by far the most common cause in Europe and Asia [6][7][8]. Further, gallstone-related disease is much less frequent outside of the USA.…”

“…Likewise, no patients in a European cohort were diagnosed with acute viral hepatitis [6]. Although a Korean cohort had the highest percentage of acute hepatitis B infection (12%), it was still less common than pregnancy-related liver disease [9].…”

HELLP Sendromunda Acil Yaklaşım

“…Böylelikle, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT) düzeyleri artar. Vakalar›n %30'unda gama glutamil transferaz (GGT), alkalin fosfataz (ALP) ve bilüribinlerde orta düzeyde art›fl görülebilir (14) . Preeklempside, hyaluronik asit düzeyindeki art›fl HELLP sendromu için güvenilir bir belirteçtir.…”