Hepatic disease and pregnancy: an overview of diagnosis and management.

OBJECTIVES To provide a review of the current literature on hepatic disease in pregnancy, outlining the incidence, pathophysiology, diagnosis, and management of major diseases in this category. DESIGN A thorough review of expert analysis, case reports, and randomized clinical trials was used to assess current methods of managing the major diseases related to hepatic dysfunction in pregnancy. A review of bibliographies was also utilized. RESULTS Hepatic disease complicates nearly 3% of all pregnancies and is a significant cause of morbidity during the gravid state. However, several diseases, including HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), acute fatty liver of pregnancy, acute cholestasis of pregnancy, ruptured liver hematoma, and preeclampsia, can be managed with successful outcomes for both the mother and fetus if diagnosed in early stages. Astute clinical judgment and laboratory evaluation of the patient is vital in the appropriate diagnosis of hepatic disease in pregnancy. CONCLUSIONS Early intervention and appropriate diagnosis can substantially reduce the morbidity and mortality associated with hepatic derangements of pregnancy.