scholarly journals Liver diseases unique to pregnancy

Medicina ◽  
2008 ◽  
Vol 44 (5) ◽  
pp. 337 ◽  
Author(s):  
Jūratė Kondrackienė ◽  
Limas Kupčinskas
Keyword(s):  
Fatty Liver ◽  
Liver Diseases ◽  
Hyperemesis Gravidarum ◽  
Correct Diagnosis ◽  
Late Pregnancy ◽  
First Trimester ◽  
Third Trimester ◽  
Liver Disorders ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver

The aim of this review article is to improve knowledge of the liver disease in pregnancy. The article summarizes the results of own experience and the recent reviews of liver disorders unique to pregnancy. Abnormalities in liver tests occur in 3% of pregnancies with causes ranging from self-limiting to rapidly fatal. In Kaunas University of Medicine Hospital, a retrospective analysis disclosed a rate of 0.52% of liver diseases in 16252 pregnant women over a 5-year period. Several liver diseases occur only during pregnancy and are considered to be associated with the pregnant state. The liver disorders unique to pregnancy have characteristic clinical features and timing of onset. Hyperemesis gravidarum occurs in the first trimester, intrahepatic cholestasis of pregnancy in the second or third trimester, preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and acute fatty liver of pregnancy usually in the third trimester. The disorders of late pregnancy – preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy – may progress to severe liver dysfunction. The correct diagnosis is critical, as any delay can result in morbidity or mortality of both the mother and fetus. Early delivery and advances in supportive management are the only available option for improving the prognosis.

scholarly journals Pregnancy-related liver pathology: hyperemesis gravidarum, cholestatic hepatosis of pregnancy, preeclampsia/eclampsia, HELLP-syndrome, acute fatty liver of pregnancy

2021 ◽  
Vol 1 ◽  
pp. 7-16
Author(s):  
О.V. Golyanovskiy ◽  
N.E.  Geints ◽  
V.V.  Mekhedko ◽  
S.V.  Frolov
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Pregnant Women ◽  
Liver Dysfunction ◽  
Hellp Syndrome ◽  
Liver Diseases ◽  
Hyperemesis Gravidarum ◽  
Late Pregnancy ◽  
Risk Groups ◽  
Acute Fatty Liver

Liver disease associated with pregnancy affects up to 3% of women and is a common cause of dysfunction during pregnancy. Severe liver dysfunction is associated with high rates of maternal and infant morbidity and mortality.Therefore, it is important to know about liver diseases the woman suffered before pregnancy in order to adequately manage the pregnancy and reduce the number of complications during delivery. Research and recent advances in medicine tend to improve the consequences, but so far they have not shown significant reduction of the maternal and perinatal morbidity rates against the background of this pathology. Liver diseases that are characteristic for pregnancy can be classified into those of early pregnancy (hyperemesis gravidarum) and those of late pregnancy (preeclampsia/eclampsia, intrahepatic cholestasis of pregnant women; hemolysis, increased activity of liver enzymes) HELLP-syndrome, acute fatty liver disease of pregnant women - AFLP, liver rupture / infarction).The results of modern studies used in the practice of medical care for pregnant women with concomitant pathology have significantly improved the pregnancy and delivery outcomes, but the number of complications among the mother and the fetus is still high. In this article, we offer an overview of liver diseases complicated by pregnancy with a detailed presentation of their aetiology, pathogenesis, diagnosis, and treatment. The risk groups of pregnant women with the potential possibility of liver dysfunction development have also been identified.

scholarly journals Liver Transplantation for Acute Liver Failure at 11-Week Gestation with Successful Maternal and Fetal Outcome

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Vinaya C. Maddukuri ◽  
Courtney D. Stephenson ◽  
Lon Eskind ◽  
William A. Ahrens ◽  
Preston Purdum ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Liver Enzymes ◽  
First Trimester ◽  
Fetal Outcome ◽  
Third Trimester ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
First Trimester Of Pregnancy

Acute liver failure (ALF) during pregnancy is very uncommon. Pregnancy-specific liver conditions like hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and acute fatty liver of pregnancy can cause ALF at term or postpartum, but, typically occur during the third trimester. Most of these patients recover spontaneously after delivery, but, on occasion, they require liver transplantation in the postpartum period. However, ALF during the first and second trimester of pregnancy requiring antepartum liver transplantation is rare. Only fifteen cases of liver transplantation during pregnancy have been reported, and very few occurred during the first trimester. We report a Woman who developed acute liver failure during the first trimester of pregnancy and underwent successful liver transplantation at 11-week gestation, followed by successful delivery of the fetus at 30 weeks. To our knowledge, this is the earliest case of successful liver transplantation during pregnancy followed by successful fetal outcome. We discuss management of the patient and fetus before, during, and after liver transplantation and review the literature on antepartum liver transplant in pregnancy.

scholarly journals Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Sau Xiong Ang ◽  
Chie-Pein Chen ◽  
Fang-Ju Sun ◽  
Chen-Yu Chen
Keyword(s):  
Cohort Study ◽  
Fatty Liver ◽  
Retrospective Cohort Study ◽  
Hellp Syndrome ◽  
Retrospective Cohort ◽  
Liver Enzymes ◽  
Neonatal Outcomes ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

The Hibernating Bear—A Good Analogy to Explain Why Acute Fatty Liver of Pregnancy Manifests in Late Pregnancy

2018 ◽  
Vol 113 (2) ◽  
pp. 307-308 ◽  
Author(s):  
Uday Zachariah ◽  
Ashish Goel ◽  
K A Balasubramanian ◽  
C E Eapen
Keyword(s):  
Fatty Liver ◽  
Late Pregnancy ◽  
Acute Fatty Liver ◽  
Good Analogy

The liver in pregnancy

2013 ◽  
pp. 309-318
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Liver Disease ◽  
Hyperemesis Gravidarum ◽  
Gallstone Disease ◽  
Liver Function Tests ◽  
The Other ◽  
Liver Disorders ◽  
Hepatic Rupture ◽  
Chiari Syndrome ◽  
Acute Fatty Liver ◽  
In Pregnancy

Liver disease in pregnancy Liver function tests in pregnancy Hyperemesis gravidarum Obstetric cholestasis Acute fatty liver of pregnancy Pre-eclampsia HELLP syndrome Spontaneous hepatic rupture Gallstone disease Pancreatitis Budd–Chiari syndrome Viral hepatitis Pre-existing cirrhotic liver disease A number of liver disorders are unique to, or more likely to occur in, pregnancy. These should be considered alongside the other causes of liver disease that occur in non-pregnant patients. Transient mild derangements of LFT are common and rarely require further assessment beyond repeat monitoring to ensure normalization. However, liver disorders in pregnancy often present non-specifically and, therefore. all patients merit formal clinical assessment....

scholarly journals Determinants and Measurement of Neonatal Vitamin D: Overestimation of 25(OH)D in Cord Blood Using CLIA Assay Technology

2019 ◽  
Vol 105 (4) ◽  
pp. e1085-e1092
Author(s):  
Mengdi Lu ◽  
Bruce W Hollis ◽  
Vincent J Carey ◽  
Nancy Laranjo ◽  
Ravinder J Singh ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cord Blood ◽  
Late Pregnancy ◽  
First Trimester ◽  
Controlled Study ◽  
Positive Bias ◽  
Third Trimester ◽  
Serum Samples ◽  
Human Cord Blood ◽  
Blood Samples

Abstract Context Vitamin D (VD) deficiency in pregnancy and the neonatal period has impacts on childhood outcomes. Maternal VD sufficiency is crucial for sufficiency in the neonate, though the effect of early versus late pregnancy 25-hydroxy-vitamin D (25(OH)D) levels on neonatal levels is unknown. Furthermore, chemiluminescence immunoassays (CLIAs) are widely used, though their validity in measuring 25(OH)D specifically in cord blood specimens has not been established. Objective To assess the validity of a CLIA in the measurement of cord blood 25(OH)D and to evaluate maternal determinants of neonatal 25(OH)D, including early versus late pregnancy 25(OH)D levels. Design This is an ancillary analysis from the Vitamin D Antenatal Asthma Reduction Trial (VDAART), a randomized, double-blinded, placebo-controlled study. Participants and Intervention A total of 881 pregnant women at high risk of having offspring asthma were randomized to receive VD supplementation or placebo. Serum samples were collected from mothers in early and late pregnancy and from offspring cord blood at birth. 25(OH)D levels were assayed by CLIA in all maternal and offspring samples and by LC-MS/MS in all offspring samples and a subset of 200 maternal third trimester samples. Results Cord blood 25(OH)D levels were higher as measured by CLIA (mean 37.13 ng/mL [SD 18.30]) than by LC-MS/MS (mean 23.54 ng/mL [SD 11.99]), with a mean positive bias of 13.54 ng/mL (SD 12.92) by Bland-Altman analysis. This positive bias in measurement by CLIA was not observed in maternal samples. Third trimester 25(OH)D was a positive determinant of neonatal 25(OH)D levels. Conclusion Chemiluminescence immunoassays overestimate 25(OH)D levels in human cord blood samples, an effect not observed in maternal blood samples. The quantification of 25(OH)D by CLIA should therefore not be considered valid when assayed in cord blood samples. Third trimester, but not first trimester, maternal 25(OH)D is one of several determinants of neonatal 25(OH)D status.

scholarly journals Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts

2014 ◽  
Vol 40 (3) ◽  
pp. 641-649 ◽  
Author(s):  
Hisanori Minakami ◽  
Mamoru Morikawa ◽  
Takahiro Yamada ◽  
Takashi Yamada ◽  
Rina Akaishi ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Liver Enzymes ◽  
Platelet Counts ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver

scholarly journals Acute Fatty Liver of Pregnancy and its Differentiation from Other Liver Diseases in Pregnancy

2015 ◽  
Vol 75 (08) ◽  
pp. 844-847 ◽  
Author(s):  
J. Maier ◽  
E. Schalinski ◽  
C. Häberlein ◽  
U. Gottschalk ◽  
L. Hellmeyer
Keyword(s):  
Fatty Liver ◽  
Liver Diseases ◽  
Acute Fatty Liver ◽  
In Pregnancy

scholarly journals Presumed acute fatty liver of pregnancy following influenza A hepatitis

2017 ◽  
Vol 10 (4) ◽  
pp. 186-188 ◽  
Author(s):  
Adam Morton
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Fatty Liver ◽  
Influenza A ◽  
Fatty Infiltration ◽  
Influenza Virus Infection ◽  
Acid Oxidation ◽  
Reye's Syndrome ◽  
Third Trimester ◽  
Acute Fatty Liver

Acute fatty liver of pregnancy is a rare mitochondrial hepatopathy characterised by microvesicular fatty infiltration, and is believed to be due to impaired fatty acid oxidation. Hepatitis following influenza virus infection is uncommon. Rarely influenza virus infection may be complicated by Reye's syndrome, another hepatic microvesicular fat disease. A case of influenza A hepatitis in third trimester of pregnancy, followed by the evelopment of presumed acute fatty liver of pregnancy is described in this report and a potential mechanism why this may have occurred is discussed.

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