Liver disease in pregnancy
Pregnancy related liver disease represents a challenging problem. Often, there is overlap between many of the individual conditions. In general, if any of the following conditions have occurred in one pregnancy, there is a high likelihood of occurrence in a subsequent pregnancy.
The term HELLP syndrome has been used since 1982 and is associated with breakdown in red blood cells (haemolysis H), elevated liver enzymes (EL) and finally low platelets (LP). It often is difficult to differentiate this between pre-eclampsia related to liver disease in the third trimester. Often, there is a previous history of poor pregnancy outcome. Up to 5% of women who develop pre-eclampsia may develop this more severe complication. It presents with kidney failure in up to 10% of patients and liver test abnormalities may peak even 48 hours after delivery. The risk of recurrence in subsequent pregnancies is up to 5%.
Management of these conditions is all about early delivery when appropriate, management of high blood pressure. There is increasing evidence that aspirin use from week 11 in pregnancy reduces the risk of pre-eclampsia. If high blood pressure occurs in one pregnancy, it is likely to occur again.