Makindo Medical Notes

🌸 Liver disease in pregnancy – Affects maternal and fetal outcomes; needs early recognition. – ⚠️ 8% of pregnancies have low platelets — always get early specialist input.

🦠 Viral Hepatitis

• Seen in pregnancy — HAV and especially HEV can be more severe than in non-pregnant patients.
• ⚠️ Most common cause of jaundice in pregnancy.
• Screen at-risk mothers for HBV → reduce vertical transmission with antivirals + neonatal vaccination.

🍟 Acute Fatty Liver of Pregnancy (AFLP)

• ⏳ Occurs in the 3rd trimester, especially in primigravida.
• RUQ pain, nausea, vomiting, rapid progression → acute liver failure within days.
• Often associated with preeclampsia, pancreatitis, hypoglycaemia.
• 🛑 Obstetric & medical emergency — requires ICU, early delivery, sometimes transplant. Mortality remains high.
• Bloods: PT/APTT prolonged, ↓ fibrinogen, markedly ↑ AST/ALT & bilirubin.

🌙 Intrahepatic Cholestasis of Pregnancy (ICP)

• Intense itching + jaundice in 2nd–3rd trimester.
• Bilirubin up to x9 normal; AST/ALT ~600 IU/L.
• Triggered by cholestatic effect of oestrogens in genetically predisposed women.
• Treatment: Symptomatic only — cholestyramine, antihistamines; ursodeoxycholic acid may help.
• ⚠️ May recur in future pregnancies. Severe cases → consider early delivery to reduce fetal risk (stillbirth).

💉 Preeclampsia

• Triad: Hypertension + proteinuria + oedema.
• Usually after 28 weeks; presents with nausea, vomiting, hypertension, swelling.
• LFTs: ALT/AST can be very high (e.g. 1100 IU/L) but bilirubin usually normal.

🚨 HELLP Syndrome

• Haemolysis, Elevated LFTs, Low Platelets.
• 3rd-trimester: RUQ pain, nausea, vomiting, hypertension.
• Platelets <80, AST/ALT often >1000, bilirubin x15 normal, low haptoglobin.
• May progress to DIC, liver infarction/rupture → intraperitoneal bleeding (surgical emergency).
• Treatment: Early delivery. If <37 weeks → give steroids for fetal lung maturation first.

📚 Exam Pearls for OSCE: – Jaundice in pregnancy → always think “Viral hepatitis, AFLP, ICP, HELLP.” – 🧪 AFLP vs HELLP: both have ↑ LFTs, but HELLP has haemolysis + thrombocytopenia; AFLP often with hypoglycaemia. – ⚠️ Management is always early delivery + supportive care once diagnosed.