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

Abstract

Grayscale abdomen ultrasound (US) is routinely performed in pregnant women with suspected pregnancy-related liver dysfunction, but its diagnostic yield is very low. We aimed to investigate the association between Doppler-US findings, liver stiffness measurement (LSM) and different causes of pregnancy-related liver dysfunction. This is a prospective cohort study of pregnant women referred to our tertiary center for any suspected gastrointestinal disease between 2017 and 2019 and undergoing Doppler-US and liver elastography. Patients with previous liver disease were excluded from the analysis. For group comparisons of categorical and continuous variables, the chi-square test or Mann–Whitney test, and the McNemar test were used, as appropriate. A total of 112 patients were included in the final analysis, of whom 41 (36.6%) presented with suspected liver disease: 23 intrahepatic cholestasis of pregnancy (ICP), six with gestational hypertensive disorders and 12 cases with undetermined causes of elevated liver enzymes. Values of LSM were higher and significantly associated with a diagnosis of gestational hypertensive disorder (AUROC = 0.815). No significant differences at Doppler-US or LSM were found between ICP patients and controls. Patients with undetermined causes of hypertransaminasemia showed higher hepatic and splenic resistive indexes than controls, suggesting splanchnic congestion. The evaluation of Doppler-US and liver elastography is clinically useful in patients with suspected liver dysfunction during pregnancy. Liver stiffness represents a promising non-invasive tool for the assessment of patients with gestational hypertensive disorders.

Diagnostic Approach to Elevated Liver Function Tests during Pregnancy: A Pragmatic Narrative Review

“…In other studies, altered LFTs were investigated in the third trimester (or at delivery), with a reported prevalence of 11–13% [ 5 ]. Elevated LFTs were not always explained with pre-existing or pregnancy-related liver disease (30–50%) [ 5 , 91 ], and more importantly, could be associated with a higher risk of complications [ 5 ]. Finally, the incidence of NAFLD among pregnant women is rapidly increasing and is associated with an elevated risk of maternal complications and pre-term birth [ 92 , 93 ].…”

“…Future studies aimed at evaluating the true prevalence of altered LFTs of an “unknown” origin, risk factors, and more importantly, association with maternal and fetal outcomes are eagerly awaited. Moreover, the role of the abdomen Doppler ultrasound and elastography [ 91 , 99 , 100 ] in the diagnostic work of these patients warrants further research.…”

“…This pathophysiological condition could create a continuum, and liver involvement could be present also in the absence of hypertension, as seen in some cases of HELLP syndrome [1,97]. In fact, a recent study [91] found significant changes in the splanchnic hemodynamics evaluated with Doppler ultrasound in patients with an undetermined cause of hypertransaminasemia when compared to controls, similar to what was seen in patients with pre-eclampsia [98]. Future studies aimed at evaluating the true prevalence of altered LFTs of an "unknown" origin, risk factors, and more importantly, association with maternal and fetal outcomes are eagerly awaited.…”