Liver Disease in Pregnancy Intrahepatic Cholestasis of Pregnancy (ICP) • Onset/Trimester: 25-32 weeks • Typical clinical features: Pruritus, Mild jaundice, Elevated bile acids, Vitamin K ↓ • Aminotransferases: Mild to 10-20-fold elevation, Bilirubin: <5 mg/dL • Hepatic imaging: Normal • Histology: Normal-mild cholestasis, no necrosis HELLP Syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) • Onset/Trimester: 3 or post-partum • Typical clinical features: Hemolysis, Thrombocytopenia(<50,000 often) • Aminotransferases: Mild to 10-20-fold elevation, Bilirubin: <5 mg/dL unless massive necrosis • Hepatic imaging: Hepatic infarcts, Hematomas, rupture • Histology: Patchy/extensive necrosis and hemorrhage Acute Fatty Liver of Pregnancy (AFLP) • Onset/Trimester: 3 or post-partum • Typical clinical features: Liver failure with coagulopathy, encephalopathy, hypoglycemia. DIC • Aminotransferases: 300-500 typical but variable ++, Bilirubin: often <5 mg/dL, higher if severe • Hepatic imaging: Fatty infiltration • Histology: Microvesicular fat in zone 3 BWH Medicine Chiefs @BrighamChiefs #Liver #Disease #Pregnancy #hepatology #obstetrics #hepatitis #comparison #differential #diagnosis #icp #HELLP #AFLP
