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• more on pregnancy specific disorders and on liver disease incidental to pregnancy
  oscar,m jolobe
  Published on: 15 April 2010

• Published on: 15 April 2010

  more on pregnancy specific disorders and on liver disease incidental to pregnancy

  • oscar,m jolobe, retired geriatrician

  Among the pregnancy-specific liver disorders(1), obstetric cholestsis(OC) has been the subject of a recent study which has made important contributions to the diagnosis of this disorder. As a result of simultaneous chromatographic measurement of 15 bile acids from the 16th week of pregnancy onwards, the authors noted that, from the 24th week, OC was associated with predominant increase in cholic acid conjugated with tau...

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  Among the pregnancy-specific liver disorders(1), obstetric cholestsis(OC) has been the subject of a recent study which has made important contributions to the diagnosis of this disorder. As a result of simultaneous chromatographic measurement of 15 bile acids from the 16th week of pregnancy onwards, the authors noted that, from the 24th week, OC was associated with predominant increase in cholic acid conjugated with taurine and glycine. The cholic/chenodeoxycholic acid acid ratio was also significantly higher in OC than in normal pregnant women. A 3-week course of ursodeoxycholic acid significantly reduced serum concentrations of taurocholic and taurodeoxycholic acid in these OC patients(2). Among the observations which have been made on liver disease incidental to pregnancy(1), mention also needs to be made of the hepatopulmonary syndrome clinically manifesting itself for the first time during the 25th week of pregnancy where it could easily have been mistaken for pulmonary embolism. This was the case of a 35 year old primigravida with liver cirrhosis attributable to non-alcoholic steatohepatitis. She presented with exertional dyspnoea progressing to dyspnoea at rest, the latter releived by lying flat. The co-existence of hypoxia prompted referral for ventilation perfusion scanning so as to confirm or refute pulmonary embolism(PE). The scan was interpreted as having low probability of PE. However, the accumulation of radionuclide in the brain and kidneys was indicative of a right to left shunt. The latter diagnosis wa confirmed by contrast echocardiography which showed opacification of the left ventricle with a delay of 6-7 heartbeats after injection of irritated saline. In view of the fact that, six weeks postpartum, a repeat lung scan and repeat contrast echocardiography showed a decrease in shunt size, the authors postulated that pregnancy might have induced conversion of previously clinically quiescent intrapulmonary venous dilatation into clinically overt hepatopulmonary syndrome References (1) Mackillop L., Williamson C Liver disease in pregnancy Postgrad Med J 2010;86:160-4 (2)Tribe RM., Dann AT., Kenyon AP et al Longitudinal profiles of 15 serum bile acids in patients with intrahepatic cholestasis of pregnancy Am J Gastroenterol 2010;105:585-95 (3)Sammour RN., Zuckerman E., Tov N., Gonen R Pregnancy exacerbating hepatopulmonary syndrome Obstetrics and Gynecology 2006;107:455-7

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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