Studies of hepatic function: IV. Hepatic function during pregnancy

Abstract

1.1. In a group of 34 normal pregnant women, the serum bilirubin concentration ranged from 0.2 to 1.0 mg. per 100 c.c. Normal results were obtained with the bromsulphalein test in 26 cases; one case showed 20 per cent retention and 7 showed from 5 to 10 per cent retention.2.2. Similar studies were performed upon 26 women with toxemia of pregnancy. In 2 cases of eclampsia the serum bilirubin concentration was 1.08 and 0.8 mg. per 100 c.c., and there was bromsulphalein retention of 60 and 20 per cent, respectively. Hyperbilirubinemia was noted in 3 and dye retention (30 per cent) in 2 of 4 patients with a moderate grade of toxemia. Dye retention (from 10 to 30 per cent) was present in 3 of 20 cases of mild toxemia, all of whom presented normal serum bilirubin values.3.3. Dye retention (5 per cent) was found in 2 of 4 pregnant women with advanced chronic glomerulonephritis and renal failure, in one with carcinoma of the ovary (5 per cent), and in 2 with pyelitis (5 and 15 per cent, respectively).4.4. Studies were made in 15 cases before and twenty-four hours after delivery. An increase in the degree of bromsulphalein retention was noted in 3 patients, all of whom had received an anesthetic at the time of delivery. The serum bilirubin concentration rose in 6 cases, fell in 5, and remained practically unchanged in 4 cases. It appears that impairment of dye elimination is more readily produced by anesthetic agents in the pregnant than in the nonpregnant state.5.5. These data suggest that although the serum bilirubin concentration remains within normal limits during normal pregnancy, some degree of hepatic functional impairment is present in a not inconsiderable proportion of cases. The degree of demonstrable impairment of hepatic function in patients with toxemia of pregnancy does not parallel the severity of the toxic manifestations. Studies of hepatic function are, however, of considerable diagnostic value in this connection.