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Liver Disease In
Pregnancy
Gopisankar.M.G
2008MBBS
Physiologicalchangesin pregnancy
• Palmar Erythema, vascular spiders
• Placenta  Alkaline Phosphatase in last trimester
•...
Liver diseases
1. Pregnancy Induced Liver disease
• Hyperemesis Gravidarum
• Obstetric Cholestasis
• AFLP
• Pre- eclampsia...
Obstetric Cholestasis
• Intra hepatic cholestasis of pregnancy / icterus gravidarum
Aetiology
• Normal pregnancy –mildly c...
Clinical features
• Generalised severe Pruritis in third trimester
• More in palms , soles, trunk
• Rarely jaundice may fo...
Management
• LFT frequently
• Antepartum Fetal surveillance and Induction at 38 weeks is
ideal
• Continuous CTG at time of...
Maternal and Perinatal Prognosis
• Inc perinatal mortality and morbidity
• Fetal distress
• Unexplained IUD – due to acute...
Liver disease in pregnancy
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Liver disease in pregnancy

  1. 1. Liver Disease In Pregnancy Gopisankar.M.G 2008MBBS
  2. 2. Physiologicalchangesin pregnancy • Palmar Erythema, vascular spiders • Placenta  Alkaline Phosphatase in last trimester • Bilirubin and Transaminase levels are normal
  3. 3. Liver diseases 1. Pregnancy Induced Liver disease • Hyperemesis Gravidarum • Obstetric Cholestasis • AFLP • Pre- eclampsia and HEELP syndrome 2. Coincidental Liver Disease • Viral Hepatitis • Drug Induced Jaundice 3. Pregnancy superimposed on Chronic Liver Disease • Congenital hyperbilirubinaemia • Cirrhosis • Chronic Hepatitis
  4. 4. Obstetric Cholestasis • Intra hepatic cholestasis of pregnancy / icterus gravidarum Aetiology • Normal pregnancy –mildly cholestatic/retarded biliary flow • Due to estrogen • Also genetic basis • 50% family history • Inc bile acids in circulation • h/o pruritis on OCP anticipate tendency for cholestasis in pregnancy
  5. 5. Clinical features • Generalised severe Pruritis in third trimester • More in palms , soles, trunk • Rarely jaundice may follow the pruritis after 2-4weeks • Significant hepatosplenomegaly is unlikely • Investigations • Abnormal LFT • Elevated s.bile acids ,Alkaline Phosphatase ,SGOT ,SGPT-mild • If very high SGOT/PT(>250) think of hepatitis • Elev. S.bilirubin –but not > 5g/dL • USG –exclude Gall stones
  6. 6. Management • LFT frequently • Antepartum Fetal surveillance and Induction at 38 weeks is ideal • Continuous CTG at time of labour • Vitamin K administration –reduce chance of PPH and Fetal intracranial haemorrhage • Pruritus  Ursodeoxycholic acid -300mg BD hydrophilic bile acid • Releives symptoms ,normalise LFT – reduce the proportion of hydrophobic and hepatotoxic bile acids • Another option is Cholestyramine  but won’t corrects LFT
  7. 7. Maternal and Perinatal Prognosis • Inc perinatal mortality and morbidity • Fetal distress • Unexplained IUD – due to acute anoxia • No IUGR /Oligamnios so USG and Doppler are not helpful • Fetal coagulopathy • IC bleed - Vit K deff. • Maternal morbidity  Malbsorption and Vitamin K deff.  prolongation of clotting time and PPH • Jaundice usually disappears after 1-2 weeks of delivery • Recurrence – may happens , and with use of OCP with estrogen
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Liver disease in Pregnancy

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