Liver Disease in Pregnancy

Rowen K. Zetterman, MD


April 08, 2013

In This Article

Preeclampsia and Eclampsia

Sometimes called "toxemia of pregnancy," preeclampsia typically develops in the late second or third trimester or during the first few days following delivery. It is defined by systemic hypertension (blood pressure > 140/90 mm Hg), proteinuria > 300 mg per 24 hours, and edema. An affected patient might have 1, 2, or all 3 of these features. Preeclampsia develops in 5%-10% of pregnancies and can result in placental ischemia.[24] Occurrence of a seizure defines eclampsia.

Risk factors include young maternal age (<16 years), advanced maternal age (> 45 years), first pregnancy, preexisting systemic hypertension, obesity, and a family history of preeclampsia.[19,25,26] Symptoms include right upper quadrant pain, nausea, vomiting, and headache. Laboratory changes include aminotransferase elevation up to 10 times normal levels, with bilirubin levels usually < 5 mg/dL. Liver histology is not required for the diagnosis but would show periportal liver cell necrosis, sinusoidal thrombin deposition, and intraparenchymal hemorrhage. Complications of severe preeclampsia include hepatic infarction, intrahepatic hematoma, portal vein thrombosis, and hepatic rupture.

Maternal mortality from preeclampsia is uncommon,[25] and fetal mortality is 1%-2% as a result of placental abruption, preterm delivery, and low birth weight.[27] Treatment includes delivery of the fetus if gestation is beyond 34 weeks, anti-hypertensives to control blood pressure, and administration of magnesium sulfate should seizures occur.[28]