Hepatic Disease Associated with Pregnancy
• Pre-eclampsia• Hypertension, proteinuria, dependent pitting edema in the third trimester
• HELLP syndrome hemolytic anemia with schistocytes, elevated liver enzymes, low platelet (due to DIC)
• Morphology:
• fibrin deposition in periportal sinusoids
• hemorrhage into space of Disse
• periportal hepatocellular coagulative necrosis
Congested liver of HELLP syndrome
Hepatic Disease Associated with Pregnancy• Acute fatty liver of pregnancy (AFLP)
• sub-clinical hepatic dysfunction to hepatic failure, coma and death
• Abnormality in beta-oxidation of fatty acids
• 3rd trimester; with multiple metabolic defects
• diagnosis depends on:
• high index of suspicion
• characteristic microvesicular steatosis demonstrated on frozen tissue sections OR with stain (oil red-O or Sudan black)
• Treatment: termination of pregnancy
Acute fatty liver of pregnancy: lobular parenchyma characterized by microvesicular steatosis and a small number of lymphocytes. (H&E)
Hepatic Disease Associated with Pregnancy
• Intrahepatic cholestasis of pregnancy• Characteristics:
• onset of pruritus in 3rd trimester
• darkening of urine with occ. light stools
• jaundice – conjugated hyperbilirubinemia
• Mechanism: altered hormonal state + biliary secretion defects cholestasis
• Increased incidence of fetal distress, stillbirth and prematurity