PDF(Pubmed)
Abstract：
Liver diseases in pregnancy can be specific to gestation or only coincidental. In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction-associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.Critical relevance statement Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.Key points• Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.• Fear of radiation should never delay necessary imaging studies.• Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.• Common liver conditions and lesions may take an unexpected turn during pregnancy.• Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival.
摘要：
怀孕期间的肝病可能是妊娠特有的，也可能是偶然的。在后一种情况下，诊断可能很困难。快速诊断母胎紧急情况和需要专门干预的情况对于保护母体肝脏和保证母胎存活至关重要。虽然对患者的详细询问和临床检查非常重要，成像通常是必不可少的，以达到这些肝脏疾病和病变的诊断。妊娠期间可观察到三组肝脏疾病：（1）与妊娠有关的疾病：妊娠肝内胆汁淤积症，先兆子痫,子痫,溶血,肝酶升高和低血小板（HELLP）综合征，和妊娠急性脂肪肝；（2）在怀孕期间更频繁或因怀孕而加剧的肝脏疾病：急性单纯疱疹性肝炎，布加综合征,出血性遗传性毛细血管扩张症,肝细胞腺瘤，门静脉血栓形成,和胆石症；(3)巧合的情况，包括急性肝炎,偶然的局灶性肝脏病变，代谢功能障碍相关的脂肪变性肝病，肝硬化,肝细胞癌，肝脓肿和寄生虫病,和肝移植。需要对主要影像学发现的特定知识才能达到早期诊断，为了充分的后续行动，并避免对母亲和胎儿造成不良后果。关键相关性声明妊娠相关肝病是妊娠患者肝功能障碍的最重要原因，在怀孕期间,即使是常见的肝脏疾病也会有意想不到的转变。对辐射的恐惧绝不应推迟怀孕期间必要的影像学检查。要点•妊娠相关的肝脏疾病是妊娠期肝功能障碍的最常见原因。•对辐射的恐惧绝不应延迟必要的成像研究。•肝脏成像对于评估肝脏紧急情况以及任何其他肝脏疾病的诊断和随访非常重要。•常见的肝脏疾病和病变可能在怀孕期间发生意外转变。•必须迅速识别妊娠特异性疾病，如先兆子痫和HELLP综合征。然而,当被认为是母胎生存急迫时,影像学检查不应延迟分娩.
