Disease | Symptoms | New onset hypertension | Gestational age at diagnosis | Laboratory findings | |
Aminotransferase levels | Other findings | ||||
Hyperemesis gravidarum | Persistent vomiting accompanied by weight loss exceeding 5% of pre-pregnancy body weight and ketonuria unrelated to other causes. | No | Onset in the first trimester. Often continues into the early second trimester, but usually resolves by 20 weeks of gestation. | Abnormal liver chemistries occur in approximately 50% of patients who are hospitalized because of the disease. Alanine aminotransferase (ALT) is typically elevated to a greater degree than aspartate aminotransferase (AST). Values for both are typically only mildly elevated. |
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HELLP syndrome (Hemolysis, Elevated Liver chemistries, and Low Platelets) | Most common symptom is abdominal pain and tenderness in the midepigastrium, right upper quadrant, or below the sternum. Many patients also have nausea, vomiting, and malaise. Headache, visual changes, and jaundice may occur but are uncommon. Liver rupture is rare. | Yes, in 85% of cases | Onset in the second half of pregnancy, usually in the third trimester. First recognition of disease may be postpartum, usually within 48 hours of delivery. | AST >2 times upper limit of normal for local laboratory (usually >70 international units/L). Marked elevations in the setting of hepatic infarction. |
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Preeclampsia with severe features | New-onset cerebral or visual disturbance (eg, severe headache, photopsia [flashes of light], scotomata [dark areas or gaps in the visual field], altered mental status) and severe, persistent right upper quadrant or epigastric pain are most common symptoms. Pulmonary edema may occur. | Yes, in 100% of cases | Onset in the second half of pregnancy, usually in the third trimester. Can also present postpartum, usually within 48 hours of delivery. | Transaminase levels ≥2 times upper limit of normal for a specific laboratory. |
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Intrahepatic cholestasis of pregnancy | Pruritus is the cardinal sign, and ranges from mild to intolerable. It is often generalized, but typically starts and predominates on the palms and soles and is worse at night. Right upper quadrant pain, nausea, poor appetite, sleep deprivation, or steatorrhea may occur. | No | Onset typically in the late second or the third trimester. Transient first trimester symptoms have been linked to ovarian hyperstimulation syndrome. | Serum aminotransferases are elevated in 60% of cases, and usually less than two times the upper limit of normal, but may reach values greater than 1000 international units/L. |
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Acute fatty liver of pregnancy | Initial symptoms may be nonspecific (eg nausea, vomiting, abdominal pain, malaise, and/or anorexia), but patients may develop manifestations of acute liver failure including jaundice, encephalopathy, coagulopathy and/or hypoglycemia. | Yes, on occasion | Onset usually in third trimester, but the diagnosis has been made as early as 22 weeks of gestation and as late as four days after delivery. | Modest elevations, up to 500 international units/L. |
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