Pregnancy and liver disease.
Liver disease in pregnancy should be considered in 3 categories: pre-existing disease, disease peculiar to pregnancy and coincident acute liver or gall-stone disease. In addition the time of onset of diagnosis in terms of the trimester of gestation must be verified, as the diseases peculiar to pregancy have a characteristic time of onset. In the last trimester closes obstetric management is required for the constellation of abnormal liver function tests, nausea and/or vomiting and abdominal pain. This may be due to severe pre-eclampsia, HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome or acute fatty liver of pregnancy with or without sub-capsular hepatic haematomas, amongst which there is an overlap. Early delivery is curative. A molecular basis consisting of long chain 3-hydroxyl CoA dehydroxegenase deficiency in heterozygote mothers underlies this clinical syndrome. Ursodeoxycholic acid is now established treatment for intra-hepatic cholestasis of pregnancy and appears to improve foetal outcome. Hepatitis B vaccination and immunoglobulin at birth prevents chronic hepatitis B in children of HBsAg (hepatitis B surface antigen) positive carrier mothers.
Burroughs
A K
AK
Hepato-biliary and Liver Transplantation Unit, The Royal Free Hospital, London, England, UK.
D015094:3-Hydroxyacyl CoA Dehydrogenases / Q000172:deficiency / Q000235:genetics; D015746:Abdominal Pain / Q000503:physiopathology; D000208:Acute Disease; D002648:Child; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002769:Cholelithiasis / Q000175:diagnosis; D036861:Delivery, Obstetric; D005234:Fatty Liver / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000175:diagnosis / Q000503:physiopathology; D006406:Hematoma / Q000175:diagnosis; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines; D019694:Hepatitis B, Chronic / Q000517:prevention & control; D006579:Heterozygote; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D009325:Nausea / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D014611:Vaccination; D014839:Vomiting / Q000503:physiopathology
D002756:Cholagogues and Choleretics; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014580:Ursodeoxycholic Acid; D015094:3-Hydroxyacyl CoA Dehydrogenases