Pathologies

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It should be taken into account that the lab tests can be disturbed by pregnancy. For example, there is a two- to fourfold increase in alkaline phosphatases due to placental production. There are three liver diseases that occur exclusively during pregnancy.

Presents in pregnant patients with pruritus and increased bile salts. This is the most frequent pregnancy-related liver disease. Pathogenesis is based on a dysfunction of bile transporters in patients with a genetic predisposition. From the 26th week onwards, the patient develops pruritus without a rash and there is a significant increase in serum bile salts.

The prognosis is usually benign for the mother. It gives rise to 20% mortality in the child. There is a risk if the bile salts are >40 micromol/l. The disease disappears immediately after induction of labor. Recurrence may occur in a subsequent pregnancy. Treatment consists of ursodeoxycholic acid (15mg/kg/day) and induction of pregnancy.

Presents in pregnant patients with pruritus and increased bile salts. This is the most frequent pregnancy-related liver disease. Pathogenesis is based on a dysfunction of bile transporters in patients with a genetic predisposition. From the 26th week onwards, the patient develops pruritus without a rash and there is a significant increase in serum bile salts. The prognosis is usually benign for the mother. It leads to 20% mortality in the child. There is a risk if the bile salts are > 40 micromol/l. The disease disappears immediately after induction of labor. Recurrence may occur in a subsequent pregnancy. Treatment consists of ursodeoxycholic acid (15 mg/kg/day) and induction of pregnancy.

Presents with abnormal liver tests and right hypochondrium pain in the pregnant patient. HELLP syndrome occurs in 1 in 1000 pregnancies in the second and third trimester. This is a systemic endothelial dysfunction. HELLP syndrome is part of preeclampsia. This is characterized by proteinuria, edema and increased blood pressure. Biochemically, hemolysis is found (H), increased transaminases above 100 IU/l (EL: Elevated Liver Tests) and decreasing platelets < 100000. Endothelial dysfunction can lead to liver hematomas due to rupture. This gives a mortality of 1 to 3% in the mother and 30% in the child. Treatment consists of addressing preeclampsia and early induction of labor.

Presents as acute liver failure during pregnancy. It occurs in 1 in 7,000 to 1 in 13,000 pregnant women in the third trimester. The pathogenesis is not well understood, but is probably due to accumulation of free fatty acids. Biochemically there are signs of acute liver failure, such as an increase in the INR. However, there is no strong increase in ALT. It has a high mortality for mother and child. Treatment is induction and if necessary liver transplantation.

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