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Liver Disease in Pregnancy: DR Amita Suneja Professor, OB & GYN Ucms & GTBH
Liver Disease in Pregnancy: DR Amita Suneja Professor, OB & GYN Ucms & GTBH
Dr Amita Suneja
Professor, OB & GYN
UCMS & GTBH
Challenging disease to manage
Because of physiology of pregnancy
certain disorders take more ominous
course in pregnancy than in non pregnant
state and some are unique to pregnancy
May have severe maternal & fetal effects
USG-normal
AFLP or HELLP
AFLP HELLP
Normal BP Can occur in normal BP
No haemolysis Had EL & LP
Less thrombocytopenia No hypoglycemia
Marked coagulopathy
Treatment
19U FFP & 10U cryoprecipitate
LSCS 5hrs later for AFD, Male baby A&H
Hysterectomy for PPH
D2- moderate ascitis, thrombocytopenia,
coagulopathy, jaundice
D3- marked icterus, semicomatose,
hypoglycemia, metabolic acidosis
- waiting list: cadaveric liver transplant
- deep coma, convulsions, cerebral edema
D11- patient died, liver bx taken
Acute Fatty Liver Of Pregnancy
Rare & fatal disorder
50% mortality, with early diagnosis & T/t
mortality is 20%
More common in primi gravida & multiple
pregnancy
Mildly raised enzymes, -ve viral markers,
dominantly hypoglycemia & coagulopathy,
Normal USG
Treatment is supportive management &
termination of pregnancy.
Ac fulminant failure liver transplant,
If starts improving- full recovery
LCHAD (long chain 3-hydroxyacyl-coenzyme A
dehydrogenase) deficiency in fetus no
oxidation of Fatty acids in fetus
maternal liver gets overwhelmed with
FA in heterzygous mother AFLP
Both parents r heterozygous for this defect
Case History II
24yrs,G2P1+0+0+1, 34 wks, intense pruritis
H/O pruritis & jaundice in previous pregnacy
ANC in this preg N, no nausea or vomiting
Examination
No icterus or hepatosplenomegaly or tenderness
scratch marks +ve, no evidence of scabies
Obstetric exam uneventful
Investigations
S Bb 3mg%, Direct 2mg%
AST 200U/L, ALT 104 U/L, ALP 400IU/L
PT - normal
Differential diagnosis
IHCP
Obstructive jaundice
Further investigations
USG liver to rule out obsruction of the
biliary tract - normal
Viral markers normal
If diagnosis is still in doubt due to unusual
features confirmatory serum tests should
be total bile acids (TBA) which are raised
IHCP
IIIrd trimester, Recurrent, Mild icterus (Bb is
not > 5 mg%)
No prodrome, itching, ALP, TBA, n USG
Counselling maternal & fetal risk
Relief of maternal symptoms- phenobarbitone
Ursodeoxycholic acid 300mg bd
Addition of SAMe (S adnosylmethionine) to
UDCA ? benefit;
VIT K
Terminate pregnancy at 37 weeks
Etiology:
genetic mutation of MDR3 gene
- hypersensitivity to oestrogens
Environmental
Future pregnancy
Recurrence
No OCP
No progesterone in next pregnancy
IgM HAV +ve Anti HEV +ve
Similar course, PTL, Severe course in preg
PPH, No perinatal 20% fatal
transmission 50% of fulminant hepatitis
IG to baby 0.02ml/kg IM if No vaccine for it
infection within 2 weeks
of delivery or immediate Supportive T/t
postpartum Maternal outcome fatal if
Vaccination to mother fetus dies of hepatitis
when she moves to No carrier stage
endemic area
IG to mother 0.02ml/kg
deep IM within 2 weeks of
exposure to index case
Positive HBsAg, IgM anti HBc, HBeAg