Episode 15 : Liver Disease in Pregnancy

  • Episode Written By : Kyla Freeman, FM PGY3
  • Episode Reviewed By : Jack Heard, OBGYN PGY5
  • Hosts : Kyla Freeman FMR3, Patricia Massel MD-CCFP, Caitlin Blewett FMR1
  • Art : Aikansha Chawla, MS4

In this episode we review some of the liver diseases of pregnancy including cholestasis, HELLP syndrome, Acute Fatty Liver Disease of Pregnancy, Cholecystitis, and Hepatitis B and C. We hope this episode helps you broaden your differential when it comes to these patients as well as think about and recognize some rare, but serious liver disorders in pregnancy.


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  • Castillo E, Murphy K, van Schalkwyk J, Infectious disease committee. SOGC Clinical Practice Guideline No. 342-Hepatitis B and pregnancy. J Obstet Gynaecol Can. 2017;39(3):181-190. http://dx.doi.org/10.1016/j.jogc.2016.11.001
  • Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, et al. Ursodeoxycholic acid versus placebo in women in with intrahepatic cholestasis of pregnancy (PITCHES) : A randomised controlled trial. Lancet. 2019;394:849-860. http://dx.doi.org/10.1016/ S0140-6736(19)31270-X
  • Donck M, Veracruysse Y, Alexis A, Rozenberg S, Blaiberg S. Acute Fatty Liver of Pregnancy (AFLP) – A short review. Aust N Z J Obstet Gynaecol. 2021;61:183-187. https://doi.org/10.1111/ajo.13293
  • Girling J, Knight CL, Chappell. Green-top Guideline No.43 Intrahepatic cholestasis of pregnancy. 2022;129;e95-e114. DOI: 10.1111/1471-0528.17206. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/intrahepatic- cholestasis-of-pregnancy-green-top-guideline-no-43/
  • Goldberg E, O-Donovan DJ. Vertical transmission of hepatitis C. Eds. Weisman LE, Rand EB, Di Bisceglie AM. UpToDate. https://www.uptodate.com/contents/vertical-transmission-of-hepatitis-c- virus?search=hepatitis%20c%20and%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&displ ay_rank=1. Last updated August 23, 2022. Accessed September 2022.
  • Kaur AP, Kaur N, Dhillon SPS. HELLP Syndrome and its implications on maternal and perinatal outcome. Int J Reporod Contracept Obstet Gynecol. 2018;7(3):1007-1011. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180882.
  • Lausman AY, Al-Yaseen E, Sam D, Nitsch R, Barrett JFR, Chan W. Intrahepatic Cholestasis of Pregnancy in women with multiple pregnancy: An analysis of risks and pregnancy outcomes. J Obstet Gynaecol Can. 2008;30(11):1008-1013. DOI : 10.1016/S1701-2163(16)32995-4
  • Lexicomp. Ursodeoxycholic acid (ursodiol) : Drug Information. UpToDate. https://www.uptodate.com/contents/ursodeoxycholic-acid-ursodiol-drug- information?source=auto_suggest&selectedTitle=1~1—1~4—ursode&search=ursodeoxycholic%20acid#F13966873. Accessed May 2022.
  • Money D, Boucoiran I, Wagner E, Dobson S, Kennedy A, Lohn Z, Krajden M, et al. Obstetrical and Neonatal Outcomes Among Women Infected with HCV and their Infants. J Obstet Gynaecol Can. 2014;36(9):785-794. DOI : 10.1016/S1701- 2163(15)30480-1
  • Naoum EE, Leffert LR, Chitilian HV, Gray KJ, Bateman BT. Acute Fatty Liver of Pregnancy : Pathophysiology, anesthetic implications, and obstetrical management. Am Society of Anesthesiologists. 2019;130:446-461. DOI : 10.1097/ALN.0000000000002597
  • Nelson DB, Byrne JJ, Cunningham FG. Acute fatty liver of pregnancy. Obstet Gynecol. 2021;137:535-546. DOI: 10.1097/AOG.0000000000004289
  • Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A differential diagnostic challenge. GebFra Science J Review. 2019;80:499-507. DOI https://doi.org/10.1055/a-1091-8630
  • Society of Obstetricians and Gynecologists of Canada [SOGC]. Chapter 16 Hypertensive disorders of pregnancy. In: Course manual: Advances in labour and risk management. 27th ed. Canada. SOGC; 2020-2021: 382-418.
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  • World Health Organization. Hepatis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Last updated June 2022.

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