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Feature Article

Management of common hepatobiliary disorders in pregnancy

Ian Lockart, Blake Knapman, CYNTHUJA THILAKANATHAN, CHRIS POKORNY

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Abstract

Liver biochemistry results can be abnormal due to changes that occur during pregnancy. Careful history taking and examination are required to establish the cause and, if a hepatobiliary disorder is present, to determine whether it is pre-existing, coincidental or related to the pregnancy. 

Key Points

  • Liver disease is not uncommon during pregnancy and it may be pre-existing, coincidental or pregnancy related.
  • The patient’s clinical history and stage of pregnancy will help to determine the likely cause of abnormal liver biochemistry.
  • Pregnancy-related liver diseases include hyperemesis gravidarum, pre-eclampsia, intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy; they can be life-threatening and may recur in subsequent pregnancies.
  • Severe pre-eclampsia with hepatic involvement, HELLP syndrome and acute fatty liver of pregnancy are indications for delivery.
  • Babies born to mothers positive for hepatitis B surface antigen (HBsAg) should be given a dose of monovalent hepatitis B vaccine and hepatitis B immunoglobulin at birth.
  • Breastfeeding is generally safe for mothers with hepatitis B or C but should be avoided when the nipples are cracked and bleeding. 


    Picture credit: © Westend61/Miriam D/Diomedia.com

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