Liver disease in pregnancy

1. Liver Diseases
In Pregnancy
Presented By-Dr Santosh M Narayankar
Moderator-Dr G R Srinivas Rao

8. Liver Diseases Unique To
Pregnancy
• Intrahepatic Cholestasis of Pregnancy
• Preeclampsia/HELLP Syndrome
• Acute Fatty Liver Of Pregnancy

10. Intrahepatic Cholestasis
of Pregnancy

12. MDR3/ABCB4-15%

21. Maternal risks after delivery
• Increased incidence Of
• Gall stones
• Cholecystitis
• Pancreatitis
• Increased risk of
cholestasis in
subsequent pregnancy .

22. Acute Fatty Liver Of
Pregnancy

34. Preeclampsia/HELLP
Syndrome

49. Liver Diseases Not Specific to
Pregnancy

50. Viral Hepatitis
Viral hepatitis—caused by hepatitides A, B, C, D, or E;
herpes simplex; cytomegalovirus; and Epstein-Barr
virus—accounts for 40% of jaundice in pregnant women.
Hepatitides A, B, and C have the same frequency in the
pregnant and nonpregnant populations and during each
of the three trimesters of pregnancy.
Viral hepatitis does not appear to affect the pregnant
state adversely; an exception to this is hepatitis E.

51. Autoimmune Hepatitis
Reduced fertility rate secondary to amenorrhea and anovulation.
Can occur de novo during pregnancy or the postpartum period.
Pregnancy can ameliorate autoimmune hepatitis, whereas delivery
can exacerbate it.
Clinically- Asymptomatic to an acute presentation with liver failure.
Steroids and azathioprine are safe during pregnancy but birth
defects have been described.
Need careful monitoring during pregnancy and for several months
postpartum.

52. Wilson Disease
Pregnancy does not seem to have an adverse effect on the
clinical course of Wilson disease.
Recurrent abortions are common in untreated patients, which
can be seen in 26% of cases.
Untreated symptomatic women tend to suffer amenorrhea,
oligomenorrhea, irregular menses, and multiple miscarriages.
However, pregnancy is safe and successful when treatment with
a chelating drug is continued uninterrupted.
Zinc intake at a dose of 25 to 50 mg three times daily in
pregnancy appears to be safe with very minimal teratogenicity.

53. Portal Vein Thrombosis
PVT is a rare occurrence during pregnancy.
No controlled studies of anticoagulation therapy in patients
with acute PVT.
Anticoagulation therapy in acute PVT is logical but still not
firmly validated.
Chronic PVT pts should be offered screening for varices.
For varices, anticoagulation therapy should not be initiated
until after adequate prophylaxis for variceal bleeding.

54. Budd-Chiari Syndrome
Usually presents in the last trimester or the puerperium.
Treatment - No different from treatment used for nonpregnant
BCS patients, except warfarin (FDA category X).
LMWH at a curative dose should be started as soon as the
diagnosis is established.
Pharmacologic and endoscopic therapy for portal hypertension
can be applied

55. Cirrhosis And Portal Hypertension
Worsening jaundice with progressive liver failure, ascites, and hepatic
coma have been reported during the course of pregnancy in women
with cirrhosis.
Increased incidence of stillbirths, premature delivery, hypertension,
and peripartum infection in women with cirrhosis especially when
ascites is present.
Sclerotherapy or endoscopic band ligation are successful in pregnant
women with variceal hemorrhage.
Prevention of variceal bleed in known cirrhotic who desires
pregnancy is based on classic treatment with -blockers and/or
endoscopic ligature.
Prophylaxis with -blockers may be continued during pregnancy

56. Thank
You