201-POS

Abstract

Objectives Disorders associated with marked liver dysfunction in late pregnancy include pre-eclampsia, HELLP syndrome, obstetric cholestasis, and acute fatty liver of pregnancy. Accurate diagnosis and appropriate timing of delivery are required in these conditions to minimize risk of maternal and fetal morbidity/mortality. We report a case series of women with significant and persistent liver dysfunction (>3-fold rise = ALT >90 IU/L) in the third trimester, where a definitive diagnosis remained obscure using accepted diagnostic tools for these and other liver conditions. Methods A retrospective audit of 341 consecutive patients referred to the Obstetric Medicine service at a single center over a 30-month period were reviewed for the prevalence of abnormal liver function tests (LFTs). Of the 56 patients ascertained, 39 were excluded with a definitive diagnosis. Of the remaining 15 patients, 10 had severe derangement with ALT elevation >90 IU/L. Results Gestation at diagnosis ranged from 26+5 to 37+1 weeks, and rationale for requesting LFTs was uniformly concern over maternal or fetal well-being. Serum bile acids and bilirubin remained in the normal range for all patients, and 1 patient received ursodeoxycholic acid empirically. Four patients had co-existing gestational hypertension, and 8 underwent planned delivery. Outcomes were reassuring; 1 neonate developed respiratory distress requiring nursery admission (delivery Conclusions This small series outlines a group of previously undescribed patients who showed a slowly-progressive clinical course with generally good neonatal and maternal outcomes. A high rate of planned delivery was contributed to by concern over persistent abnormal LFTs, and/or the development of gestational hypertension. Disclosures C. Brumby: None. I. Idel: None. R. Still: None. L. Skeat: None. L.P. McMahon: None.