Liver Disease in Pregnancy

Question 1

What should you consider in a pregnant lady with jaundice?

Answer 1

1. Viral hepatitis
2. Gallstones
3. HELLP syndrome
4. Pre-eclampsia

Question 2

What is the screening process for maternal jaundice?

Answer 2

FBC, LFTs, clotting, viral hepatitis, a1aT, haematinics, anti-smooth muscle Abs, urinalysis.

Question 3

What is this a presentation of?
Unexplained pruritis without a rash (palms and soles, worse at night) in 2nd half of pregnancy. Mildly raised LFTs (resolves after delivery), disproportionate rise in ALP compared to ALT.

Answer 3

Intrahepatic cholestasis of pregnancy

Question 4

How is intrahepatic cholestasis of pregnancy diagnosed?

Answer 4

Diagnosis of exclusion, test for viral/autoimmune cause, USS of liver.

Question 5

What is the treatment for intrahepatic cholestasis of pregnancy?

Answer 5

1. Treat itch and abnormal LFTs with Ursodeoxylcholic acid
2. Vitamin K 10mg OD from 36/40
3. Induction of labour from 37-38/40 due to risk of stillbirth.

Question 6

What is this a presentation of?

Malaise, vomiting, jaundice, epigastric pain (early symptoms/signs). Disproportionate rise in ALT compared to ALP.

Answer 6

Acute fatty liver of pregnancy

Question 7

What are the serious sequalae of acute fatty liver of pregnancy?

Answer 7

DIC, pre-eclampsia, thrombocytopenia, hypoglycaemia

Question 8

What is the treatment for acute fatty liver of pregnancy?

Answer 8

1. Manage on HDU/ITU with supportive treatment
2. Treat hypoglycaemia aggressively
3. Correct clotting, may need blood products
4. Dialysis if severe uraemia
5. Expedite delivery