Liver diseases of pregnancy particular to the third trimester

• Published in: Primary care update for Ob/Gyns Vol. 5; no. 1; pp. 36 - 42
• Main Authors: Fisher, Deidre T., Repke, John T.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 1998
• ISSN: 1068-607X; 1878-4283
• DOI: 10.1016/S1068-607X(97)00122-4

Liver disease is a complication of pregnancy that, when it occurs, demands that one be vigilant in seeking the diagnosis for rapid and definitive treatment for the optimal outcome of both mother and fetus. Patients who present with liver abnormalities in the third trimester of pregnancy should be carefully evaluated. The differential diagnosis includes diseases that present specifically in the second or third trimester, such as acute fatty liver of pregnancy, preeclampsia or its Hemolysis, Elevated Liver function tests, Low Platelets (HELLP) syndrome variant, and intrahepatic cholestasis of pregnancy; diseases that can present at any gestational age, such as viral hepatitis, drug-induced hepatotoxicity, and cholestatic disease; and rare or uncommon diseases, such as Budd Chiari syndrome, autoimmune hepatitis, and the thrombotic microangiopathiopathies, namely, hemolytic-uremic syndrome or thrombotic thrombocytopenia purpura. Anyone presenting with a vague constellation of symptoms in latter pregnancy should be investigated further for symptoms or signs of serious liver disease.