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Prospective study of liver dysfunction in pregnancy in Southwest Wales
  1. C L Ch’ng1,
  2. M Morgan2,
  3. I Hainsworth3,
  4. J G C Kingham1
  1. 1Department of Gastroenterology, Swansea NHS Trust, Swansea, UK
  2. 2Department of Obstetrics, Swansea NHS Trust, Swansea, UK
  3. 3Department of Biochemistry, Swansea NHS Trust, Swansea, UK
  1. Correspondence to:
    Dr J Kingham, Department of Gastroenterology, Singleton Hospital, Sketty, Swansea SA2 8QA, UK;
    jkingham{at}swansea-tr.wales.nhs.uk

Abstract

Background: Liver dysfunction in pregnancy has serious consequences. Its frequency and characteristics have not been systematically documented in Britain. We have prospectively determined incidence, causes, and outcome of liver dysfunction in pregnancy in an obstetric unit in Southwest Wales, UK.

Methods: A central laboratory identified all abnormal liver tests (bilirubin >25 μmol/l, aspartate transaminase >40 U/l, or γ glutamyl transpeptidase >35 U/l) from patients in antenatal clinics and wards of an obstetric unit serving a population of 250 000. Patients with abnormal liver tests were assessed and followed through after pregnancy. Medical advice was provided to obstetric teams.

Findings: There were 4377 deliveries during the 15 month study. A total of 142 patients had abnormal liver tests. There were 206 contributing diagnoses, the great majority being pregnancy specific. Among the most important were pre-eclampsia (68), HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome (30), obstetric cholestasis (23), hyperemesis gravidarum (11), acute fatty liver of pregnancy (five), and hepatic infarct (one). Sepsis, postoperative factors, and placental pathology (51) were not uncommonly responsible but incidental or pre-existing hepatobiliary disease was infrequent (17). Sixty five patients were delivered early by induction or caesarean section because of liver dysfunction. Despite substantial liver related morbidity, there were no maternal deaths and only two intrauterine deaths.

Conclusions: Liver dysfunction was seen in 3% of deliveries during a 15 month prospective study and was usually directly related to pregnancy with spontaneous recovery in the puerperium. Incidence of the most serious conditions, acute fatty liver of pregnancy and HELLP syndrome, was much greater than previously reported. Profound effects on maternal and infant health were observed but close medical and obstetric collaboration ensured low mortality.

  • pregnancy
  • liver dysfunction
  • obstetric cholestasis
  • pre-eclampsia
  • HELLP syndrome
  • acute fatty liver of pregnancy
  • HELLP, haemolysis, elevated liver enzymes, low platelets
  • LFT, liver function tests
  • AST, aspartate aminotransferase
  • γGT, gamma glutamyl transpeptidase
  • USS, ultrasound scan
  • ERCP, endoscopic retrograde cholangiopancreatogram
  • LDH, lactate dehydrogenase
  • OC, obstetric cholestasis
  • AFLP, acute fatty liver of pregnancy
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Footnotes

  • This work was presented in part to the British Maternal and Fetal Medicine Society (London, March 2000), the American Gastroenterological Association (San Diego, May 2000; Atlanta, May 2001 and San Francisco, May 2002), the British Association for the Study of the Liver (Southampton, September 2000; London, September 2002), the British Society of Gastroenterology (Glasgow, March 2001; Birmingham, March 2002), the European Gastroenterology Week (Rome, November 2001), and the International Association for the Study of Liver (Madrid, April 2002).

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    C L Ch'ng J G C Kingham M Morgan I Hainsworth