Obstetric Liver Disease
Up to 3 % of all gestations are complicated by various liver diseases. Some of these are unique to pregnancy, whereas others are either coincidental with pregnancy or associated with preexisting chronic liver diseases. Severe liver diseases in pregnancy a
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Up to 3 % of all gestations are complicated by various liver diseases. Some of these are unique to pregnancy, whereas others are either coincidental with pregnancy or associated with preexisting chronic liver diseases. Severe liver diseases in pregnancy are rare but may lead to significant morbidities and even mortality for both mother and fetus/infant. The major pregnancy-related liver diseases comprise intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, toxaemia of pregnancy, HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet count), hepatic infarction and rupture, and hyperemesis gravidarum.
Fig. 16.1 Intrahepatic cholestasis of pregnancy. Bilirubinostasis is present in dilated canaliculi, the cytoplasm of hepatocytes, and Kupffer cells, with minimal necroinflammatory activity (bland cholestasis). Intrahepatic cholestasis of pregnancy affects about 0.3 % to 5.6 %, 0.5 % to 1.5 %, and 6 % of all gestations in the United States, Europe, and China, respectively. Women with this disorder tend to have a recurrence in subsequent pregnancies and to develop cholestasis with oral contraceptives, and have a higher risk of developing chronic liver or biliary diseases. It currently is recognised that this disorder is associated with defects of bile acid transporter proteins, including multidrug resistance 3 (MDR3; encoded by ABCB4) and bile salt export pump (BSEP; encoded by ABCB11).
A.W.H. Chan et al., Atlas of Liver Pathology, Atlas of Anatomic Pathology, DOI 10.1007/978-1-4614-9114-9_16, © Springer Science+Business Media New York 2014
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Obstetric Liver Disease
Fig. 16.2 Intrahepatic cholestasis of pregnancy. Bilirubinostasis is present in the dilated canaliculi, cytoplasm of hepatocytes, and Kupffer cells, with negligible necroinflammatory activity (bland cholestasis). Although intrahepatic cholestasis of pregnancy seldom requires a liver biopsy to establish the diagnosis, the typical histologic feature is one of bland cholestasis, with a perivenular-predominant distribution. However, this form of cholestasis also might be associated with druginduced liver injury, sepsis, shock, paraneoplastic syndrome, early large duct obstruction, and benign recurrent intrahepatic cholestasis.
Fig. 16.4 Acute fatty liver of pregnancy. The hepatocytes are distended by multiple minute fat droplets (microvesicular steatosis), imparting a swollen and foamy appearance. Tinges of bilirubin pigments also are present in the cytoplasm of hepatocytes. Microvesicular steatosis, predominantly periportal sparing, is the hallmark of acute fatty liver disease. Other histologic findings include bilirubinostasis, ceroid-laden Kupffer cells, a mild mononuclear inflammatory infiltrate in lobules and portal tracts, and, rarely, sinusoidal fibrin deposition and haemorrhage. Other causes of microvesicular steatosis, such as acute alcoholic foamy degeneration; drug/toxin-induced liver injury; and toxaemia of pregnancy/HELLP syndrome need to be considered.
Fig. 16.3 Acute fatty liver of pregnancy. A
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