Liver diseases in pregnancy: Diseases unique to pregnancy

Table 3 Preeclampsia associated liver diseases

	Severe preeclampsia and eclampsia	HELLP syndrome	Acute fatty liver of pregnancy
Time	After gestational week 22	Late second trimester to early postpartum	Third trimester
Prevalence	Increases in multiple gestation (5%-7%)	0.10%	Increases in male fetus, multiple gestations, primiparous women (0.01%)
Findings	High blood pressure; proteinuria; edema; seizure; renal failure; pulmonary edema	Abdominal pain, nausea/vomiting, overlap with findings in preeclampsia	Abdominal pain, nausea/ vomiting, jaundice, hypoglycemia and hepatic failure
Tests	Platelets > 70000; urine protein > 5 g/24 h; abnormal liver enzymes (10%)	Low platelets; hemolysis; elevated liver enzymes; prothrombin time may remain normal; normal fibrinogen	Platelets < 100000; AST and ALT 300-1000 U/L; low antithrombin III; high prothrombin time; low fibrinogen; high bilirubin; DIC
Management	Blood pressure control; beta-blockers, methyldopa, magnesium sulfate, early delivery	Prompt delivery	Prompt delivery; liver transplant
		5% maternal death 1% hepatic rupture	≤ 10% maternal death
Outcome	1% maternal death	1%-30% fetal death	Up to 45% fetal death

HELLP: Hemolysis, elevated liver function tests, and low platelet counts; DIC: disseminated intravascular coagulation; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.