1. 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

2. Congested liver of HELLP syndrome

3. 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

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

5. 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