Anaesthetic implications for liver disease in pregnancy

Abstract

### Key points Liver disease in pregnancy is not common but can be a significant cause of maternal and fetal morbidity and mortality, frequently appearing in the triennial confidential enquiries (Table 1). Fulminant hepatic failure is very rare and poses major challenges to the anaesthetist, although it is more common to see women with varying degrees of liver dysfunction, classically considered as occurring specific to pregnancy and incidental to pregnancy.1 The obstetric anaesthetist may be involved with the care of these women either at delivery or during an admission to the obstetric high dependency unit (HDU). View this table: Table 1 Number of deaths related to liver disease, including hepatic complications secondary to pre-eclampsia and eclampsia 1997–2008. *One death as a result of fulminant hepatic failure secondary to hepatic rupture, despite receiving a portocaval shunt. †One death due to liver rupture secondary to a complication of type IV Ehlers–Danlos syndrome; three cases of liver failure: one caused by alcohol abuse; one due to chronic active hepatitis that had caused acquired antithrombin deficiency; and one secondary either to AFLP or to the antiretrovirals they were taking to manage HIV infection. ‡Two deaths from bleeding due to portal hypertension; one death due to a liver abscess and peritonitis; one death due to intra-abdominal bleeding, …