Obstetrics - Liver Disease in Pregnancy

Question 1

Obstetrics - Liver Disease in Pregnancy

Hyperemisis Gravidarum

Symptoms?

Answer 1

Hyperemisis Gravidarum:

Complication of pregnancy, begins in 1st trimester - resolves around week 20 characterised by:

• Nausea and Vomitting
• Weigt loss (5% or more of pre-pregnancy weight
• Dehydration (ketosis and constipation)
• Metabolic imbalances (ketosis and thyrotoxicosis)
• Hyperolfaction (smell sensitivity)
• Ptyalism (Hyper salivation)

Question 2

Obstetrics - Liver Disease in Pregnancy

Hyperemisis Gravidarum

Investigations?

Answer 2

Investigations:

• Monitor fetal distress using CTG (Cardiotocography: Monitors fetal heart and uterine contractions)
• Bloods: FBC, U&Es, BUN, TFTs (TSH low)
• LFTs
  
  • AST,ALT>1000iu/L
  • ALT>AST
• Vitamin B levels
• USS: monitor gestation and exclude molar pregnancy

Question 3

Obstetrics - Liver Disease in Pregnancy

Hyperemisis Gravidarum

Treatment?

Answer 3

Treatment:

Medical:

• IV fluid resuscitation
• Anti-emetics: Pyridoxin, promethazine
• Nutritional support: thiamine

Complications:

• Mother:
  
  • Weight loss
  • Complications of vomitting: oesophageal rupture, renal damage, vascular depletion, Wernickke’s Encephalopathy (neuro symptoms due to lack of B vitamins)
• Fetus:
  
  • Prematurity
  • Low birth weight

Question 4

Liver Disease in pregnancy?

Intra-hepatic cholestasis of pregnancy?

What is it?

Answer 4

What is it?

Reversible hormonally influenced cholastasis:

• Cholestasis is defined as a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts.
• Therefore, the clinical definition of cholestasis is any condition in which substances normally excreted into bile are retained.

Causes:

• Unknown but thught to be linked to increased hormone levels
• Increased risk with multiple pregnancies

Symptoms:

• Pruritis especially on hands, spreading to face and trunk
• Jaundice
• steatorrhoea

Question 5

Liver Disease in pregnancy?

Intra-hepatic cholestasis of pregnancy?

Investigations & Treatments?

Answer 5

Investigations:

• Monitor fetal distress using CTG
• Bloods: FBC, U&E, BUN, LFTs = AST/ALT<1000iu/L, GGT=normal
• Bile acids=high
• Bilirubin<6mg/dl
• Urinalysis
• USS

Treatment:

• Medical: ursodeoxycholic acid, antihistamines
• Delivery of fetus after 37 weeks or when fetal distress apparent

Question 6

Liver Disease in pregnancy?

Intra-hepatic cholestasis of pregnancy?

Complications?

Answer 6

Mother:

• Severe pruritis
• Deranged clotting (due to inc vit K levels)

Fetal:

• Fetal distress
• Stillbirth
• Meconium aspiration/ingestion