Centre Hospitalier Intercommunal de Créteil, Service d’hépato-gastroentérologie, 40, avenue de Verdun, 94010 Créteil
Liver damage specific to pregnancy differs depending on the term of onset. The clinical manifestations are variable but these attacks have the particularity of being revealed by hepatic cytolysis. Hyperemesis gravidarum (HG) occurs at the very early stage of pregnancy, and is defined by prolonged vomiting and weight loss. HG is usually a reversible condition as soon as the vomiting stops. Third trimester liver damage is more complex and has an impact on fetal and/or maternal survival. Intrahepatic cholestasis of pregnancy is characterised by pruritus associated with cytolysis and increased bile acid levels. Poor fetal outcome can occur with intrauterine death. It is sometimes difficult to differentiate between preeclampsia, HELLP syndrome and acute fatty liver of pregnancy. Preeclampsia is defined by high blood pressure, proteinuria and liver damage with cytolysis and hemolysis in its HELLP form. Acute fatty liver of pregnancy is differentiated by the onset of rapidly progressive liver failure and hypoglycemia, but it can sometimes be associated with high blood pressure or proteinuria, making the diagnosis difficult. Prompt delivery remains the only treatment. Fetal death remains high.