Intrahepatic cholestasis of pregnancy

HELLP syndrome is a thrombotic microangiopathy of pregnancy, a severe-feature variant of preeclampsia defined by hemolysis, transaminases at least twice the upper limit of normal, and a platelet count under 100,000/uL. Delivery is the only curative treatment; management pairs blood pressure control and magnesium sulfate seizure prophylaxis with prompt, gestational-age-guided delivery.

Acute fatty liver of pregnancy is a rare, life-threatening third-trimester disorder of microvesicular hepatic steatosis driven by a fetal-maternal fatty-acid oxidation mismatch (classically LCHAD deficiency); it is treated by immediate delivery, the only intervention that reverses the maternal disease.

Hyperemesis gravidarum is severe, persistent first-trimester vomiting causing starvation ketosis and at least a 5% loss of prepregnancy weight, distinguishing it from ordinary nausea and vomiting of pregnancy. Management follows a stepwise antiemetic ladder from doxylamine-pyridoxine through IV fluids, thiamine, and refractory-line corticosteroids.

New-onset hypertension after 20 weeks of gestation with proteinuria or end-organ dysfunction, driven by abnormal placental spiral artery remodeling and widespread endothelial dysfunction. Eclampsia is preeclampsia complicated by seizures; magnesium sulfate treats and prevents seizures, and prompt delivery is the only definitive cure for both.

Acute cholangitis is a bacterial infection of an obstructed biliary tree, classically presenting as Charcot triad of fever, right upper quadrant pain, and jaundice and progressing to septic shock when drainage is delayed. Diagnosis follows the Tokyo Guidelines and severity grade, and treatment combines prompt broad-spectrum antibiotics with biliary drainage, most often by ERCP.

Choledocholithiasis is a gallstone that has migrated into the common bile duct, causing obstructive jaundice and cholestatic liver chemistries and predisposing to acute cholangitis and gallstone pancreatitis. Risk is stratified by ASGE criteria and confirmed by MRCP, endoscopic ultrasound, or therapeutic ERCP, which clears the duct before same-admission cholecystectomy.

Primary biliary cholangitis is an autoimmune, T cell-mediated destruction of small and medium intrahepatic bile ducts that presents with fatigue and pruritus in middle-aged women and a cholestatic liver chemistry pattern. Diagnosis requires two of three criteria (elevated alkaline phosphatase, positive antimitochondrial antibody, compatible biopsy), and lifelong ursodeoxycholic acid is first-line treatment, with obeticholic acid or fibrates added for inadequate biochemical response.

Hepatitis E virus is a fecal-oral or foodborne RNA virus with four genotypes that usually causes self-limited acute hepatitis resembling hepatitis A, but carries a high mortality risk in pregnant patients and can become chronic in immunocompromised hosts, especially solid-organ transplant recipients. Diagnosis rests on HEV IgM or RNA, treatment is supportive for acute disease and ribavirin for chronic infection, and prevention is safe water and thoroughly cooked pork or venison.

Hepatitis A virus is a fecal-oral RNA virus that causes acute, host-immune-mediated hepatitis with a prodrome followed by jaundice, aminotransferases often exceeding 1,000 U/L, and full recovery in at least 90% of patients within 3 to 6 months. Diagnosis rests on HAV IgM, treatment is supportive, and prevention centers on a 2-dose inactivated vaccine plus prompt postexposure prophylaxis.

Scabies is an intensely pruritic skin infestation with the mite Sarcoptes scabiei, transmitted by close skin-to-skin contact and classically involving the finger web spaces, wrists, axillae, and genitals while sparing the face and scalp in adults. Diagnosis is clinical, confirmed by mineral oil microscopy when needed, and treatment is topical permethrin or oral ivermectin with simultaneous treatment of contacts.

Gestational diabetes mellitus is carbohydrate intolerance first identified in the second or third trimester, diagnosed with a 50-g glucose challenge test followed by a confirmatory 100-g oral glucose tolerance test. Insulin is first-line pharmacologic therapy when glycemic targets are not met with diet and exercise, and untreated hyperglycemia drives fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and later maternal type 2 diabetes.