Liver disease in pregnancy can be a very challenging situation for the doctor and a difficult situation for the pregnant woman. The incidence of liver disease in pregnancy is 3-5%. Some liver problems are unique to pregnancy whereas others are unrelated. Prompt recognition of the liver disease can prevent complications and save the life of both the mother and the baby.
The liver disease in pregnancy can be placed broadly placed into three categories as follows:
Coinciding with pregnancy (viral hepatitis/ gall stones/drugs/ infection)
Underlying chronic liver problems along with pregnancy (Hepatitis B/ C, Autoimmune Hepatitis/Cirrhosis)
Diseases unique to pregnancy (Hyper emesis gravidarum /Cholestasis of pregnancy/ Pre eclampsia/ HELLP syndrome/Acute fatty liver of pregnancy) .These conditions usually resolve spontaneously or following delivery.
A pregnant woman having abnormal liver function test should undergo a standard workup as a non pregnant lady but the management can be challenging given the need of not only the pregnant mother but one has to consider the unborn foetus also.
The initial workup includes blood tests and imaging techniques. Ultrasound can be safely done in pregnant ladies. MRI is also considered safe from the second trimester onwards. CT scan however should be avoided.
Liver conditions unique to pregnancy
Hyperemesis gravidarum: here there is excessive vomiting to the extent that the lady is not able to tolerate any food/liquids. Treatment of this is symptomatic and supportive with medicines to curb vomiting, drips are given to prevent dehydration.
Intrahepatic cholestasis of pregnancy: Here the patient usually presents with itching all over the body .She is put on ursodeoxycholic acid and given injections for baby s lung maturity. Early delivery is recommended in this condition after 37 weeks as there may be risk to the baby if pregnancy is prolonged.
Pre eclampsia/ HELLP syndrome: In pregnant patients having high BP along with albumin in their urine (preeclamsia) the disease severity increases if the liver gets involved and such patients need to be delivered early and require care in a high risk pregnancy unit. In HELLP syndrome along with the above there is low platelet and breaking of red blood cells . These patients also need an early delivery in a high risk pregnancy unit along with medicines to control high blood pressure, platelet transfusion and drugs to prevent fits in the mother.
Acute fatty liver of pregnancy: This is a serious complication which needs immediate delivery in a ICU set up .
Other liver disorders
Viral hepatitis in pregnancy (jaundice): This is managed in the same way as in non pregnant individuals.
Hepatitis B / hepatitis C in pregnancy: Infants born to mothers with hepatitis B need to be given immunoglogulins and hepatitis B vaccine at birth. Nothing much needs to be done for the mother in these cases. Delivery and breast feeding is done as in normal pregnant women.
Gallstones in pregnancy: This condition is managed surgically if gallstones are causing recurrent infections. Silent stones can be left for operation post delivery.
So we see that while some liver diseases are unique to pregnancy, others can coincide with it. The doctor has a big task of managing the diseases keeping the health of the mother as well as the unborn child in consideration!