Liver disease in pregnancy is uncommon, acute viral
hepatitis being the most frequent. The latter has a normal prognosis in pregnancy, with the possible exception of NANB
hepatitis in India and North Africa. Immunization of neonates born of mothers suffering from acute or chronic HBV is essential and effective.
Acute fatty liver of pregnancy has a better prognosis than previously thought, perhaps due to diagnosis of milder cases or improved
intensive care. Its etiology is still unknown, but metabolic stress may be important. The
confusion and overlap of AFLP, the
HELLP syndrome, and
liver disease of
eclampsia suggest common etiological factors. Urgent delivery of the fetus is recommended in AFLP. The related condition of acute liver
rupture may be diagnosed by ultrasound. Successful
conservative management has been reported.
Estrogens are involved in the pathophysiology of ICP, but this does not explain the profound racial differences in incidence. The nature of the sensitivity to
estrogens is not understood, although reduced membrane fluidity, which may be counteracted by
S-adenosyl-L-methionine, is one possible explanation. The increased fetal loss associated with ICP suggests that treatment should be more energetic than hitherto. In the worst affected individuals,
fetal malnutrition secondary to maternal
steatorrhea may be an important factor. In general, patients with chronic
liver disease have increased maternal and particularly fetal mortality.