The Yield of Abdominal Ultrasound in the Evaluation of Elevated Liver Enzymes during the Second and the Third Trimester of Pregnancy

Abstract

Aims: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. Methods: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis. All patients underwent abdominal ultrasound. A significant finding of this study led to a change in treatment. Results: One hundred and twenty patients (41.8%) met inclusion criteria: 93 (77.5%) had a normal scan and 27 (22.5%) had abnormal findings. Significant ultrasound findings were found only in 2 (1.6%) patients: gallstones in the common bile duct and suspected autoimmune hepatitis. There were no significant differences between patients with and without ultrasound findings in the rate of cholestasis of pregnancy, preeclampsia, chronic hypertension, and gestation diabetes. Conclusion: Abdominal ultrasound examination in this population has a low clinical yield. The decision to perform an abdominal ultrasound must be individualized based on the obstetric history, clinical findings, and the level of liver enzymes.

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

“…Therefore, a timely clinical evaluation and diagnostic work-up are crucial for the adequate management of patients with elevated liver enzymes and suspected liver disease during pregnancy. Abdomen US is almost routinely performed in these cases; however, its diagnostic yield has often been reported quite low [ 6 , 7 ]. We hypothesized that the inclusion of the Doppler evaluation and the measurement of liver stiffness could improve the diagnostic performance of ultrasonography and the understanding of the physiopathology of liver disease during pregnancy.…”

“…Abdomen ultrasound (US) is usually performed routinely in pregnant women with elevated liver enzymes and suspected liver dysfunction; however, the diagnostic yield of this technique has been questioned [ 6 , 7 ]. In fact, US is not usually required to establish a diagnosis of pregnancy-related liver disease, with the exception of acute fatty liver of pregnancy [ 1 ], and clinically significant US findings leading to a change in management were found only in two out of 120 (1.6%) cases in a large retrospective cohort [ 6 ].…”

“…Abdomen ultrasound (US) is usually performed routinely in pregnant women with elevated liver enzymes and suspected liver dysfunction; however, the diagnostic yield of this technique has been questioned [ 6 , 7 ]. In fact, US is not usually required to establish a diagnosis of pregnancy-related liver disease, with the exception of acute fatty liver of pregnancy [ 1 ], and clinically significant US findings leading to a change in management were found only in two out of 120 (1.6%) cases in a large retrospective cohort [ 6 ]. On the other hand, other authors have suggested that maternal venous hemodynamics are dysfunctional in some pregnancy-related liver diseases, such as pre-eclampsia; therefore, its evaluation by Doppler-US may play an important role in the diagnostic work-up of these patients [ 8 ].…”