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LIVER DISEASE AND PREGNANCY: EARLY IDENTIFICATION OF THOSE AT GREATEST RISK

Student thesis: Doctoral ThesisDoctor of Philosophy

Historically, women with pre-existing liver disease were advised against pregnancy due to concerns regarding the potential for worsening of liver function, hepatic decompensation and death. The available literature detailing outcomes of pregnancy in women with liver disease is sparse, combining this with the fact that the term “liver disease” incorporates a spectrum of severity from a variety of underlying aetiologies means that generic advice regarding pregnancy risk is clearly not appropriate for all women. In addition, women with previously normal hepatic function may develop acute liver failure in pregnancy which is associated with high morbidity and mortality. Data regarding early identification of women at high risk of death from liver failure is lacking.

This body of work addresses the paucity of information regarding pregnancy risk in women with liver disease. The potential risks related to pregnancy for the mother, baby and graft in the context of different diseases and underlying severity are explored and detailed. Pre-conception parameters are identified which can predict poor pregnancy outcomes in women with different aetiologies of liver disease and severity. The King’s College Hospital poor prognostic criteria in patients with pregnancy associated acute liver failure (ALF) are shown not to be applicable to this unique cohort of patients and alternative early poor prognostic indicators are suggested.

This work should enable individualised advice regarding pregnancy risk to be given to women with liver disease who are considering pregnancy, increase our understanding of specific complications a women may encounter and aid identification of women they may benefit from liver transplantation.
Original languageEnglish
Awarding Institution
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Award date2016

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