Liver disease in pregnancy

Table 1 Features of pregnancy-associated liver diseases

Disease	Timing of occurrence	Clinical features	Histology
Hyperemesis gravidarum	First trimester	Nausea, vomiting, weight loss, nutritional deficiency	No distinct histopathology, may see normal tissue or hepatocyte necrosis, bile plugs, steatosis
Preeclampsia/eclampsia	Second/third trimester	Hypertension, edema, proteinuria, neurological deficits (headaches, seizures, coma)	Periportal hemorrhage, necrosis, fibrin deposits, may see microvesicular fat
Syndrome of hemolysis, elevated liver tests, and low platelets (HELLP)	Third trimester	Abdominal pain, nausea, vomiting, edema, hypertension, proteinuria	Necrosis, periportal hemorrhage, fibrin deposits
Acute fatty liver of pregnancy (AFLP)	Third trimester	Nausea, vomiting, abdominal pain, fatigue, jaundice	Microvesicular fat
Intrahepatic cholestasis of pregnancy (ICP)	Second/third trimester	Pruritus, jaundice, fatigue, abdominal pain, steatorrhea	Centrilobular cholestasis, no inflammation