Kumar Clark Physiological Changes Pregnancy

Question 1

What happens to hepatic blood flow during pregnancy?

Answer 1

It remains constant. As plasma and blood volumes increase, percentage of CO delivered to liver decreases, which has an effect on drug metabolism.

Question 2

What happens to LFTs?

Answer 2

Liver biochem unchanged BUT
Serum ALP increases (from the placenta)
Total protein decreases due to increased plasma volume

Question 3

Changes in other serum tests?

Answer 3

Rise in:

• Triglycerides
• Cholesterol
• Caeruloplasmin
• Transferrin
• Alpha1-antitrypsin
• Fibrinogen

all due to increased hepatic synthesis

Question 4

Give examples of pregnancy-induced liver pathology? (4)

Answer 4

• Hyperemesis gravidarum can be assoc with liver dysfunction and jaundice
• Intrahepatic cholestasis of pregnancy
• PET (pre-eclampsia) can cause subcapsular haematoma and infarction, and fulminant liver failure and HELLP
• Acute fatty liver disease of pregnancy