Prospective evaluation of abnormal liver function tests in pregnancy.

Area of Science:

• Obstetrics and Gynecology
• Hepatology
• Maternal-Fetal Medicine

Background:

• Abnormal liver function tests (LFT) in pregnancy are common, especially in the third trimester, and can have severe outcomes.
• Prospective data on the spectrum and prognosis of liver disease in pregnant women in South India is limited.

Purpose of the Study:

• To assess the causes of abnormal LFT in pregnant women.
• To prospectively determine the maternal and perinatal outcomes of liver dysfunction during pregnancy.

Main Methods:

• Evaluation of all abnormal LFT results from pregnant patients from January 2003 to January 2005.
• Prospective follow-up throughout pregnancy, including laboratory investigations (coagulation, renal function, viral markers).
• Specific evaluation of maternal and perinatal outcomes for third-trimester liver dysfunction.

Main Results:

• 125 patients had abnormal LFTs; 57.6% were pregnancy-specific.
• Third trimester showed most abnormal LFTs (59.2%), with HELLP syndrome (28.3%) and AFLP (14.8%) being most common.
• Third-trimester liver dysfunction (74 patients) led to significant complications, including DIC (20.2%), with overall and perinatal mortality rates of 20.2% and 24.6% respectively.

Conclusions:

• Liver dysfunction in pregnancy is often pregnancy-related, particularly in the third trimester.
• The incidence of AFLP and HELLP syndrome is higher than previously reported, associated with poor maternal and fetal outcomes.
• Third-trimester liver dysfunction necessitates careful management due to high mortality and morbidity risks.