Prospective study of liver dysfunction in pregnancy in Southwest Wales

Ch'ng, C.L.; Morgan, M.; Hainsworth, I.; Kingham, J.G.C.
December 2002
Gut;Dec2002, Vol. 51 Issue 6, p876
Academic Journal
Background: Liver dysfunction in pregnancy has serious consequences. Its frequency and characteristics have not been systematically documented in Britain. We have prospectively determined incidence, causes, and outcome of liver dysfunction in pregnancy in an obstetric unit in Southwest Wales, UK. Methods: A central laboratory identified all abnormal liver tests (bilirubin >25 μmol/l, aspartate transaminase >40 U/I, or γ glutamyl transpeptidase >35 U/I) from patients in antenatal clinics and wards of an obstetric unit serving a population of 250 000. Patients with abnormal liver tests were assessed and followed through after pregnancy. Medical advice was provided to obstetric teams. Findings: There were 4377 deliveries during the 15 month study. A total of 142 patients had abnormal liver tests. There were 206 contributing diagnoses, the great majority being pregnancy specific. Among the most important were pre-eclampsia (68), HELLP (haemolysis, elevated liver enzymes, tow platelets) syndrome (30), obstetric cholestasis (23), hyperemesis gravidarum (11), acute fatty liver of pregnancy (five), and hepatic infarct (one). Sepsis, postoperative factors, and placental pathology (51 ) were not uncommonly responsible but incidental or pre-existing hepatobiliary disease was infrequent (17). Sixty five patients were delivered early by induction or caesarean section because of liver dysfunction. Despite substantial liver related morbidity, there were no maternal deaths and only two intrauterine deaths. Conclusions: Liver dysfunction was seen in 3% of deliveries during a 15 month prospective study and was usually directly related to pregnancy with spontaneous recovery in the puerperium. Incidence of the most serious conditions, acute fatty liver of pregnancy and HELLP syndrome, was much greater than previously reported. Profound effects on maternal and infant health were observed but close medical and obstetric collaboration ensured low mortality.


Related Articles

  • intrahepatic cholestasis of pregnancy.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1224 

    A definition of the term "intrahepatic cholestasis of pregnancy" which refers to a pregnancy complication involving high levels of pregnancy hormones that obstruct the flow of bile within the liver is presented.

  • Liver Disease in Pregnancy. HUNT, CHRISTINE M.; SHARARA, ALA I. // American Family Physician;2/15/1999, Vol. 59 Issue 4, p829 

    Discusses the relationship of liver diseases in pregnancy in the context of obstetric management. Relation between pregnancy and hepatitis; Discussion on cholelithiasis in pregnancy; Background on intrahepatic cholestasis of pregnancy.

  • Hepatic hemorrhage and the HELLP Syndrome: A surgeon's perspective. Stevenson, Jean T.; Graham, Debra J. // American Surgeon;Sep1995, Vol. 61 Issue 9, p756 

    Presents a case of a liver rupture in a pregnant patient with Hemolysis, Elevated Liver Enzymes and Low Platelet count (HELLP) syndrome who survived a resuscitative thoracotomy for cardiopulmonary arrest. Hypertension-induced hepatic disease as a common cause of abdominal pain and liver function...

  • Liver Disease in Pregnancy. Knox, Tamsin A.; Olans, Lori B. // New England Journal of Medicine;8/22/96, Vol. 335 Issue 8, p569 

    Focuses on several aspects of liver disease, which can be a rare complication of pregnancy. Acute fatty-liver pregnancy; Normal physiologic changes of pregnancy that can mimic abnormalities associated with liver disease; Common symptoms associated with liver disease during pregnancy; Cholestatic...

  • Acute Fatty Liver of Pregnancy. Riely, Caroline A.; Latham, Patricia S.; Romero, Roberto; Duffy, Thomas P. // Annals of Internal Medicine;May87, Vol. 106 Issue 5, p703 

    Describes the cases of patients diagnosed with acute fatty liver of pregnancy. Characteristics of patients; Histologic findings in the patients; Complications of acute fatty liver of pregnancy.

  • ACUTE HEPATITIS E DURING PREGNANCY; MATERNAL AND FOETAL OUTCOMES. Alvi, Aftab Haider; Sabir, Omer; Ul Haq, Raja Ikram; Nawaz, Arif Amir; Riaz, Iram // Professional Medical Journal;2015, Vol. 22 Issue 11, p1379 

    Liver disorders during pregnancy may have a strong bearing on both mother and the foetus. Acute Hepatitis E is rightly considered to be an emerging infection. Loco-regional studies have shown it to be the most common cause of Acute Hepatitis in pregnant females. We carried out our study to...

  • Liver Disorders Unique to Pregnancy -- Our Experience. Appinabhavi, Arati; Maheswari, Latha; Venkatakrishnan, L. // Indian Journal of Public Health Research & Development;Oct-Dec2015, Vol. 6 Issue 4, p98 

    Background: Liver disorders unique to pregnancy are Intrahepatic Cholestasis of Pregnancy (IHCP), Syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelet count and Acute fatty liver of pregnancy. The present study is done to analyse the occurrence, complications, mode of delivery and the...

  • Intrahepatic cholestasis of pregnancy. Geenes, Victoria; Williamson, Catherine; Geier, Andreas // World Journal of Gastroenterology;5/7/2009, Vol. 15 Issue 17, p2049 

    Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile acids and increased rates of adverse fetal outcomes. The etiology of ICP is complex and not fully understood, but it is likely to result...

  • The Pharmacological Management of Intrahepatic Cholestasis of Pregnancy. Azzaroli, Francesco; Turco, Laura; Lisotti, Andrea; Calvanese, Claudio; Mazzella, Giuseppe // Current Clinical Pharmacology;Feb2011, Vol. 6 Issue 1, p12 

    Intrahepatic cholestasis of pregnancy is the most common liver disease occurring in the second half of pregnancy, characterized by pruritus and elevated serum bile acids often coupled to abnormal liver tests. Maternal prognosis is favourable with a complete symptom resolution after delivery,...


Read the Article


Sign out of this library

Other Topics