Aims: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. Methods: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis. All patients underwent abdominal ultrasound. A significant finding of this study led to a change in treatment. Results: One hundred and twenty patients (41.8%) met inclusion criteria: 93 (77.5%) had a normal scan and 27 (22.5%) had abnormal findings. Significant ultrasound findings were found only in 2 (1.6%) patients: gallstones in the common bile duct and suspected autoimmune hepatitis. There were no significant differences between patients with and without ultrasound findings in the rate of cholestasis of pregnancy, preeclampsia, chronic hypertension, and gestation diabetes. Conclusion: Abdominal ultrasound examination in this population has a low clinical yield. The decision to perform an abdominal ultrasound must be individualized based on the obstetric history, clinical findings, and the level of liver enzymes.

Keywords:
Elevated liver enzymes, Abdominal ultrasound, Intrahepatic cholestasis of pregnancy, Preeclampsia
1.
Ch'ng CL, et al: Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002;51:876-880.
2.
Than NN, Neuberger J: Liver abnormalities in pregnancy. Best Pract Res Clin Gastroenterol 2013;27:565-575.
3.
Shekhar S, Diddi G: Liver disease in pregnancy. Taiwan J Obstet Gynecol 2015;54:475-482.
4.
Hay JE: Liver disease in pregnancy. Hepatology 2008;47:1067-1076.
5.
Riely CA: Hepatic disease in pregnancy. Am J Med 1994;96:18S-22S.
6.
Bacak SJ, Thornburg LL: Liver failure in pregnancy. Crit Care Clin 2016;32:61-72.
7.
Reid R, et al: Fetal complications of obstetric cholestasis. Br Med J 1976;1:870-872.
8.
Fisk NM, Storey GN: Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988;95:1137-1143.
9.
Matin A, Sass DA: Liver disease in pregnancy. Gastroenterol Clin North Am 2011;40:335-353, viii.
10.
Di Salvo DN: Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med 2003;22:69-89.
11.
Mackillop L, Williamson C: Liver disease in pregnancy. Postgrad Med J 2010;86:160-164.
12.
Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser 2003;916:i-viii, 1-149, backcover.
13.
Carpenter MW, Coustan DR: Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-773.
14.
Haddad B, Sibai BM: Chronic hypertension in pregnancy. Ann Med 1999;31:246-252.
15.
American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy: Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122-1131.
16.
Joshi D, et al: Liver disease in pregnancy. Lancet 2010;375:594-605.
17.
Suarez B, et al: Abdominal pain and preeclampsia: sonographic findings in the maternal liver. J Ultrasound Med 2002;21:1077-1083; quiz 1085-1086.
18.
Araujo AC, et al: Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol 2006;195:129-133.
19.
Perronne L, et al: Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features. Abdom Imaging 2015;40:2839-2849.
20.
Wicke C, et al: Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options - a unicenter study. Am J Obstet Gynecol 2004;190:106-112.
21.
Lausman AY, et al: Intrahepatic cholestasis of pregnancy in women with a multiple pregnancy: an analysis of risks and pregnancy outcomes. J Obstet Gynaecol Can 2008;30:1008-1013.
22.
Gonzalez MC, et al: Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol 1989;9:84-90.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.