ABSTRACT
Hyperemesis with severe or protracted vomiting in early pregnancy, sufficient to cause fluid, electrolyte and nutritional disturbance, may be associated with abnormal liver function tests in up to 50% of cases. Worldwide, viral hepatitis is the commonest cause of hepatic dysfunction in pregnancy. Causes include: With the important exception of hepatitis E virus and herpes simplex infection, the clinical features of viral hepatitis in the pregnant woman do not differ from those in the non-pregnant woman. The pathogenesis involves a predisposition to the cholestatic effect of increased circulating oestrogens, and progestogens may also play a role. Radiological evaluation with magnetic resonance imaging, computerized tomography or US may sometimes show hepatic steatosis, but the liver may appear normal (as the fat is microvesicular). Recurrence is particularly likely in women who are heterozygous for disorders for fatty acid oxidation, so screening for long-chain 3-hydroxy-acyl-coenzyme a dehydrogenase deficiency and other fatty acid oxidation disorders may be indicated.
