title: Hemostatic issues in pregnancy-induced liver disease.
abstract: Liver diseases may be accompanied by profound changes in the hemostatic system including thrombocytopenia, decreased plasma levels of pro- and anticoagulants, and alterations in plasma levels of fibrinolysis. The net effect of the hemostatic changes in chronic and acute liver diseases is a hemostatic system that is in relative balance due to the simultaneous decline in pro- and antihemostatic drivers. A unique category of liver diseases are those induced by pregnancy. In acute fatty liver of pregnancy, profound hemostatic changes occur, which may be caused by a combination of liver failure and disseminated intravascular coagulation. Hemostatic changes in preeclampsia and HELLP syndrome are dominated by thrombocytopenia, although alterations in plasmatic coagulation may also occur. Post-partum bleeds, bleeding from cesarean section wounds, and hepatobiliary bleeds may occur in both patient groups. Patients with intrahepatic cholestasis of pregnancy do not show clinically relevant hemostatic alterations, despite biochemical evidence of liver injury.
authors.affiliation: Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.a.lisman@umcg.nl.
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
authors.affiliation: Liver Intensive Care Unit, Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Bernal
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications; D005234:Fatty Liver / Q000097:blood / Q000150:complications; D005260:Female; D017359:HELLP Syndrome / Q000097:blood; D006470:Hemorrhage / Q000097:blood / Q000150:complications; D006487:Hemostasis; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000150:complications*; D011225:Pre-Eclampsia / Q000097:blood; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D013927:Thrombosis / Q000097:blood / Q000150:complications
keywords: Bleeding; Cesarean section; Delivery; Liver disease; Post-partum; Pregnancy; Thrombosis