Study of Liver Disorders in Pregnancy and Fetomaternal Outcomes

Liver disease in pregnancy can have serious consequences and can be a challenge

for health care providers. The cause of liver disease in pregnancy may be difficult to

diagnose and making the correct diagnosis is of paramount importance, as failure to

do so can result in morbidity or mortality for not only the mother but also for her

fetus.

Although there are alterations in normal physiological and hormonal profiles

throughout the pregnancy, there are few alterations in the results of standard liver

tests, however up to 3% of all pregnancies are complicated by liver disorders.

Severe liver disease, although rare, can occur and leads to increased morbidity and

mortality for both mother and newborn infant.The amino-transferases (AST and

ALT), G-glutamyl transpeptidase (GGTP), total bilirubin, and serum bile acid level

remain within the normal range. The alkaline phosphatase rises modestly in the third

trimester. The albumin level is lower than in non pregnant women, and the

cholesterol level is higher.

Liver involvement in pregnancy is of three types, namely liver disease unique to

pregnancy, liver disease coincidental to pregnancy, and pregnancy in patients with

pre-existing liver disease. The liver diseases unique to pregnancy include

hyperemesis gravidarum, acute fatty liver of pregnancy, Intrahepatic cholestasis of

pregnancy (ICP), and pregnancy induced hypertension (PIH) related dysfunction

including pre-eclampsia and HELLP syndrome ( hemolysis, elevated liver enzymes

and low platelets). Liver disease such as acute viral hepatitis can occur in pregnancy,

and pregnancy may occur in a patient with underlying chronic liver disease,including patients with cirrhosis and portal hypertension, and patients who have

undergone liver transplantation.

There are only very few studies available about the frequency, etiological profile,

outcome, and management guidelines for pregnancy related liver disease in India.

We therefore will prospectively study the spectrum of liver disease in pregnancy and

their maternal and fetal outcome