Liver disease in pregnancy

Question 1

What is obsetric cholestasis

Answer 1

Defined as pruritus in pregnancy that resolves on delivery (associated with abnormal liver function) in the absence of other identifyable pathologies

cause -likely genetic and hormonal factors

RF- previous OC, Fhx, ethinicity, Multiple pregnancy, pruritus on COCP, Hx of liver disease, Hep C
affects 1% of preg

Question 2

Sx and Ix of obsetric cholestasis

Answer 2

Sx - prurititus (with excoritations)- palm and soles, worse at night
Raised bilirubin (and jaundice 20%)
no rash

Ix -
Bile acids - raised
LFT - raised bili
CTG- check bab
high cholesterol
Coag screen - can cause vit K def - can be high
Hep C serology

Question 3

Mx of obsetric cholestasis

Answer 3

Only Sx relief and monitoring -
Sx relief -
Ursodexycholic acid - reduce itch and LFT
Vit K supplement (if clotting bad)
Sedating antihistamine ( promethazine)
Topical emoliants

Antenatal montor -twice weekly LFTs
Twice weekly doppler/CTG
consultant lead care

Delivery -induce at 37w
+ follow up with GP for LFTs

Question 4

Complications of obsetric cholestasis

Answer 4

Premature birth, intrauterine death
Postpartum heammorge (low vit K), 
Meconium passage
liver impairment
foetal distress

Question 5

What is Acute fatty liver disease in pregnancy

Answer 5

ACute fatty liver - RARE Preg assocaited deisorder with fatty infiltration of liver
accumulation of fat in hepatocytes etc - small yellow liver on exam
likely mitochondrial disorder

RF - nullparity, multiple preg, obesity, nale foetus, pre-eclampsia

DDx - Heamolysis, elevated liver enzyme, low plt

Question 6

Sx and Ix of Acute fatty liver disease in pregnancy

Answer 6

Sx - 
3rd trimester
Nausea/vom/abdo pain
liver tenderness, jaundice, bleeding, ascites, coagulopathy Sx
50% have proteinuric HTN

NO PRURITIS

Ix -
LFT = ALT sky high
Blood glucose low
Uric acid HIGH
USS- fatty liver

Question 7

Mx and complications of Acute fatty liver disease in pregnancy

Answer 7

Supportive care -> stabilise
onse stable, delivery is the only Management to prevent deterioration

compl-
maternal death, heamorhage (from DIC), renal failure, hepatic encelopathy, sepsos
Foetal -death

Prog - maternal mortality 20%, perinatal 20-30%