Table 2.

Differential diagnoses and characteristics of liver diseases in pregnancy

DiseaseHGICPPET with liver dysfunctionHELLPAFLP
Prevalence0.3%–3.6%0.1%–5%5%–10%0.2%–0.6%0.01%
Trimester1st/2nd2nd/3rd>20 weeks2nd/3rd/postnatal2nd/3rd/postnatal
ProteinuriaYesYesYes
Plateletsdecreasedecreasedecrease
Haemolysis++
LDHincrease≥600 IU/Lincrease
ClottingMay be prolongedRisk of disseminated intravascular coagulationRisk of disseminated intravascular coagulationProlonged (PT >14 seconds or a APTT >34 seconds)
Hypoglycaemia+
Uric acidincreaseincreaseincrease
Creatinineincreaseincreaseincrease
Liver US/CTNormalExclude cholelithiasisHepatic rupture / haematoma / infarctsHepatic rupture / haematoma / infarctsOften normal, may look brightNB fatty infiltration on US is a sign of MACROvesicular steatosis (NAFLD) not MICROvesicular steatosis (AFLP)
TreatmentSupportive, rehydration, antiemetics and vitamin supplementationUrsodeoxycholic acid, anti-histamines, aqueous cream and consider delivery at 37 weeks (or sometimes before this if bile acids are greater than 100 μmol/L)Antihypertensives, consider IV magnesium sulphate and consider delivery if deterioration in maternal or fetal conditionAs per PET and urgent discussion with obstetricians regarding deliveryCorrect coagulopathy, treat hypoglycaemia and expedite delivery
ComplicationsHyponatraemia and encephalopathyPreterm labour and stillbirthEclampsia, maternal / fetal mortalityLiver rupture and maternal/fetal mortalityFulminant liver failure and maternal/fetal mortality
Recurrence15%–81%45%–90%16%–52%2%–19%Rare; 25% in defect of fatty acid beta-oxidation
  • + = present or positive; − = absent or negative; APTT = activated partial thromboplastin time; CT = computed tomography; IV = intravenous; LDH = lactate dehydrogenase; ULN = upper limit of normal; US = ultrasound; PT = prothrombin time.