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Liver Disease and Pregnancy

Overview

Liver disease that occurs during pregnancy can present a challenge for healthcare providers. Certain liver diseases are uniquely associated with pregnancy, whereas others are unrelated. The liver diseases unique to pregnancy include hyperemesis gravidarum, acute fatty liver of pregnancy (AFLP), intrahepatic cholestasis of pregnancy (ICP), and hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome.
Liver disease such as acute viral hepatitis can occur in pregnancy, and pregnancy may occur in a patient with underlying chronic liver disease, including patients with cirrhosis and portal hypertension, and patients who have undergone liver transplantation.

In the initial evaluation of a pregnant patient with abnormal liver tests, the American College of Gastroenterology (ACG) recommends these women undergo the same standard workup as that of nonpregnant individuals.
 With regard to imaging studies and/or endoscopy in pregnant women, the ACG has the following recommendations
:

Ultrasonography is safe and the preferred imaging modality for the assessment of abnormal liver studies suggestive of biliary tract disease.

Magnetic resonance imaging (MRI) with gadolinium can be used in the second and third trimester.

Computed tomography (CT) scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads).

Endoscopy is safe in pregnancy but should be deferred until the second trimester if possible.

Meperidine and propofol can be used for endoscopic sedation.

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