Hepatic Disease Associated with Pregnancy Pre-eclampsia Hypertension, proteinuria, dependent pitting edema in the third trimester HELLP syndrome  hemolytic anemia with schistocytes, elevated liver enzymes, low platelet (due to DIC) Morphology: fibrin deposition in periportal sinusoids hemorrhage into space of Disse periportal hepatocellular coagulative necrosis

Congested liver of HELLP syndrome

Hepatic Disease Associated with Pregnancy Acute fatty liver of pregnancy (AFLP) sub-clinical hepatic dysfunction to hepatic failure, coma and death Abnormality in beta-oxidation of fatty acids 3rd trimester; with multiple metabolic defects diagnosis depends on: high index of suspicion characteristic microvesicular steatosis demonstrated on frozen tissue sections OR with stain (oil red-O or Sudan black) Treatment: termination of pregnancy

Acute fatty liver of pregnancy: lobular parenchyma characterized by microvesicular steatosis and a small number of lymphocytes. (H&E)

Hepatic Disease Associated with Pregnancy Intrahepatic cholestasis of pregnancy Characteristics: onset of pruritus in 3rd trimester darkening of urine with occ. light stools jaundice – conjugated hyperbilirubinemia Mechanism: altered hormonal state + biliary secretion defects  cholestasis Increased incidence of fetal distress, stillbirth and prematurity