Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Points ++ Disease summary: Hypertensive disorders of pregnancy A spectrum of clinical disorders including pre-eclampsia, eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), and pregnancy complicated by hepatic infarction and/or rupture. Pre-eclampsia complicates approximately 5% of all pregnancies. Many women with pre-eclampsia have mildly abnormal liver function tests, but 5% to 20% of pre-eclamptic pregnancies develop HELLP syndrome. Risk factors for the development of pre-eclampsia include primiparity, older maternal age, increased body mass index, long birth interval, medical disorders including diabetes mellitus, chronic renal failure and antiphospholipid syndromes, family history of pre-eclampsia, or fetal factors including multiple pregnancy, or the presence of a hydatidiform mole. Uncomplicated pre-eclampsia is defined as the development of hypertension and proteinuria in pregnancy. Oedema is often seen. Pre-eclampsia can also be associated with abdominal pain, headaches, visual changes, and renal and liver impairment, but the liver impairment is usually mild. HELLP syndrome is a subgroup of women with pre-eclampsia and is a severe variant of the condition. Hypertension and proteinuria may be absent in up to 15% of women presenting with features of HELLP syndrome. Severe disseminated intravascular coagulation and multiorgan failure can be associated with this condition and lead to significant maternal and fetal morbidity and mortality. Hepatic hemorrhage or failure occurs in approximately 1% of pregnancies complicated by HELLP syndrome and are associated with significant mortality as fulminant liver failure may result. All of these conditions are thought to have a common etiology, and result from abnormal placentation early in gestation, when the spiral arteries fail to form low-resistance vessels as they do in normal pregnancy. Diffuse endothelial activation occurs which can result in multiorgan dysfunction later in the course of the pregnancy. Adverse fetal outcomes associated with hypertensive disorders in pregnancy include intrauterine growth restriction, placental abruption, and intrauterine death. Acute fatty liver of pregnancy This disorder is a rare and potentially life-threatening condition that occurs in pregnancy and usually presents toward the end of the third trimester. Liver dysfunction results from microvesicular steatosis (in contrast to macrovesicular steatosis which is seen in other liver disorders such as nonalcoholic fatty liver disease). More common in primigravidae, in multiple pregnancies, or pregnancies with male fetuses. Important symptoms that suggest a diagnosis of acute fatty liver of pregnancy (AFLP) include abdominal pain (particularly in the right upper quadrant), nausea, vomiting, and polydipsia on a background of malaise and anorexia. This disorder is considered part of the same spectrum as pre-eclampsia and HELLP syndrome and so the features may overlap. Severe hypertension or proteinuria is rare, however. Intrahepatic cholestasis of pregnancy Intrahepatic cholestasis of pregnancy (ICP) is the most frequent cause of cholestasis in pregnancy and is more commonly seen in certain populations (incidence in Chile and Scandinavia is 12% and 1.5%, respectively). The disorder is characterized by the development of pruritus (in the absence of a rash) which can be severe, and deranged liver function tests, in association with elevated serum bile acid concentration. It ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.