Question

Enumerate the causes of liver diseases in pregnancy.

Hint:

Liver diseases in pregnancy include conditions like intrahepatic cholestasis and acute fatty liver of pregnancy. Prompt diagnosis and management are essential to prevent complications for both mother and fetus.

Answer 1

Step 1: Causes of Liver Diseases in Pregnancy.
Liver diseases during pregnancy can arise due to various factors, either specific to pregnancy or pre-existing conditions that are exacerbated by pregnancy. The causes include:
(1) Acute Fatty Liver of Pregnancy (AFLP):
- AFLP is a rare but severe condition that occurs in the third trimester and is characterized by fat accumulation in the liver. It leads to liver dysfunction, jaundice, and coagulopathy.
(2) Intrahepatic Cholestasis of Pregnancy (ICP):
- ICP is a liver disorder seen in the second or third trimester, characterized by pruritus (itching) and elevated bile acids in the blood, leading to jaundice. It increases the risk of preterm birth and fetal distress.
(3) Pregnancy-Related Hepatic Encephalopathy:
- This is a rare condition that can occur due to hepatic dysfunction, often caused by pre-existing cirrhosis or hepatic failure. It is characterized by confusion, lethargy, and altered mental status.
(4) Viral Hepatitis:
- Hepatitis B, C, and E are common viral causes of liver disease in pregnancy. Hepatitis B (HBV) is of particular concern due to vertical transmission risk to the neonate.
(5) Pre-eclampsia/Eclampsia:
- These conditions can cause hepatic ischemia or HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), leading to liver damage and dysfunction.
(6) Non-Alcoholic Fatty Liver Disease (NAFL:
- NAFLD can worsen during pregnancy, especially in overweight or diabetic women, and may lead to steatosis, steatohepatitis, or cirrhosis.
(7) Hepatic Hemangioma:
- Pregnancy can exacerbate hepatic hemangiomas, benign tumors of the liver, potentially leading to symptoms such as pain or rupture, though these are rare.
(8) Gallbladder Disease (Cholelithiasis, Cholestasis):
- Pregnancy increases the risk of gallstones and gallbladder disease due to hormonal changes, leading to cholestasis or even gallbladder rupture.