Hepatic Dysfunction During Pregnancy. Ayman Mokhtar Kamaly, MD Professor of Anesthesiology [email protected] Most pregnant women are young & healthy.
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Hepatic Dysfunction During Pregnancy
Ayman Mokhtar Kamaly, MD
Professor of Anesthesiology
(I) Liver Diseases Unique to Pregnancy
antiemetics (± steroids).
Clinical Features and Diagnosis:
Outcome of pts. with ICP:
Subcapsular hematoma & rupture, infarction, & fulminant failure.
Acute Hepatic Hemorrhage of the Rt Lobe with a Subcapsular Hematoma.
Extensive necrosis throughout the Rt lobe with patchy necrosis in the Lt lobe
Autopsy of a eclamptic woman shows multiple regions of hepatic infarction (pale zones).
Clinical Features & Diagnosis
(1)Hemolysis (↑ indirect bil.),
(2)↑Transaminases (10-20 fold + bil. < 5 mg%),
Classification of HELLP:
Mississippi Class System:
Platelets < 50000
Platelets 100-150000 +
↑liver enzymes (LDH>600)
Differential Diagnoses of HELLP
Lt lobe Large subcapsular hematoma. Rt lobe has widespread necrosis a (heterogeneous, hypodense appearance), with “sparing” of Lt lobe.
Clinical Features and Diagnosis
AFLP: Diffuse fatty infiltration
(A): (low power), (B):(high power)
(II) Liver Diseases Occurring Coincidentally in
a Pregnant Patient
(III) The Pregnant Patient with Chronic Liver Disease