Liver Disease and Pregnancy(beta)
Official guideline from the American College of Gastroenterology.
summary by Russell Rosenblatt, MD Robert S. Brown, MD
Diagnosis and Workup
MRI without gadolinium can be used in 2nd and 3rd tri.
Biliary Disease, Liver Mass, CLD
ERCP okay if strongly indicated, e.g. biliary pancreatitis, choledocho, cholangitis.
Asymptomatic hemangioma and focal nodular hyperplasia do not need surveillance in pregnancy.
If suspect portal hypertension, screen for varices in 2nd tri.
HBIG and HBV vaccine for children with HBV-infected mothers.
Should offer tenofovir in 3rd tri if chronic HBV and viral load >10⁶ log copies/mL (200,000 IU/mL).
Screen with anti-HCV Ab if risk factors; should not screen if no risk factors.
Should minimize invasive procedures e.g. amniocentesis, invasive fetal monitoring.
Recommend early delivery at 37 weeks due to increased risk of fetal complications.
Should manage with prompt delivery; expectant mgmt not appropriate.
How strong is the ACG's recommendation?