Table 2

Typical features and differential diagnoses of pregnancy-specific liver diseases

	Hyperemesis gravidarum	Intrahepatic cholestasis of pregnancy	Pre-eclampsia with hepatic impairment	HELLP syndrome	Acute fatty liver of pregnancy
Timing of presentation in pregnancy	First trimester	Second/third trimester	After 20 weeks	Third trimester	Third trimester
Main clinical findings	Severe nausea and vomiting, dehydration, weight loss	Pruritus, jaundice	Abdominal pain, hypertension, proteinuria, headache	Abdominal pain, vomiting, hypertension, proteinuria, headache	Abdominal pain, vomiting, jaundice, encephalopathy
AST/ALT	1–5 × ULN	1–8 × ULN	2–10 × ULN	2–30 × ULN	5–15 × ULN
Bilirubin	Normal	1–6 × ULN	Normal	1.5–6 × ULN	6–8 × ULN
Bile acids	Normal	>10 µmol/L	Normal	Normal	Normal
Platelets	Normal	Normal	Normal - ↓	↓ - ↓↓	↓
Haemolysis	No	No	No	+	+
LDH	Normal	Normal	Normal - ↑	↑	↑
Fibrinogen	Normal	Normal	Normal	Normal	↓↓
Hypoglycaemia	No	No	No	No	+
Uric acid	Normal	Normal	↑	↑	↑
Creatinine	↑	Normal	Normal - ↑	Normal - ↑	↑ - ↑↑
Key steps in management	Supportive, rehydration, antiemetics	UDCA, delivery at 37 weeks	Blood pressure control, delivery after 34 weeks	Delivery, platelet transfusion, blood pressure control	Delivery, intensive care
Differential diagnosis	Hepatitis, cholecystitis, peptic ulcers, gastroenteritis, pancreatitis	Cholelithiasis, viral hepatitis, autoimmune liver disease	HUS, TTP, SLE exacerbation, septic shock	HUS, TTP, SLE exacerbation, septic shock	HUS, TTP, paracetamol toxicity, hepatitis, SLE exacerbation
Complications	Preterm birth, fetal growth restriction, Wernicke’s encephalopathy	Preterm birth, fetal distress, stillbirth	Liver haematoma, rupture, infarction, Pulmonary oedema, cerebral haemorrhage, preterm birth, fetal growth restriction	Liver haematoma, rupture, infarction, Pulmonary oedema, cerebral haemorrhage, DIC, preterm birth, fetal growth restriction	Acute liver failure, DIC, postpartum haemorrhage, acute renal failure, gastrointestinal bleeding

ALT, alanine aminotransferase; AST, aspartate aminotransferase; DIC, disseminated intravascular coagulation; HELLP, haemolysis, elevated liver enzymes, low platelets; HUS, haemolytic uraemic syndrome; LDH, lactate dehydrogenase; SLE, systemic lupus erythematous; TTP, thrombotic thrombocytopaenic purpura; UDCA, ursodeoxycholic acid; ULN, upper limit of normal.