Viral hepatitis and intrahepatic cholestasis of pregnancy

Specific serological tests which are now available for the diagnosis of infection with hepatitis A and hepatitis B viruses, were used to distinguish viral hepatitis from other causes of liver disease in pregnancy. Forty-nine (51.6%) of 95 pregnant patients had viral hepatitis, 24 hepatitis A and 25 hepatitis B. The majority of patients (26 of 28) presenting before 22 weeks gestation had viral hepatitis. By contrast, 23 (34.3%) of the remaining 67 patients presenting with abnormal liver function tests at greater than or equal to 22 weeks gestation, had viral hepatitis; the majority of the remainder had features compatible with intrahepatic cholestasis of pregnancy. Although there were significant clinical and biochemical differences between the two groups, accurate diagnosis was only possible by using specific virological tests.