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Liver Diseases Specific to Pregnancy

Evangelos Cholongitas and Andrew K Burroughs

All major organ systems undergo physiological changes during pregnancy, and the results of clinical examinations and laboratory investigations should be interpreted accor-dingly. The liver exhibits a range of altered functions, including changes in blood flow and hepatic cholesterol synthesis and secretion. Gallbladder motility decreases while the lithogenic index of bile increases [1]. Hematocrit, serum urea, uric acid, albumin, and total protein values decrease, and the presence of placental and bone isoenzymes generates an increase in alkaline phosphatase [2]. Cholesterol and triglyceride levels increase, while aminotransferase concentrations remain unchanged. Total and free bilirubin concentrations are lower in all trimesters, while conjugated bilirubin and g-glutamyltransferase (g-GT) levels are reduced only in the second and third trimesters [3]. The incidence of jaundice – the most common clinical manifestation of liver disease – is low, occurring in approximately one in 1500 pregnancies [4]. Although post partum abnormalities in liver function can occur in hepatically uneventful pregnancies, normal functionality is resumed within 5–10 days [5].

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