Onset (I/II/III trimester) | II/III, most >35 wk, rare reports <30 wk | Any | II/III (after 20 wk) |
Clinical findings | Malaise, nausea/emesis, jaundice, mental status changes, abdomen pain, ± hemorrhage, ± preeclampsia | Malaise, nausea/emesis, jaundice, abdomen pain | Malaise, hypertension, proteinuria, nausea, abdomen pain, rare jaundice, ± seizures, ± oliguria, ± coagulopathy |
Laboratory | | | |
Transaminases (U/mL) | ↑ usually <500 | ↑ commonly >1000 | Normal to ↑ 50× (> if liver hematoma) |
Bilirubin (mg/dL) | ↑ usually 3-10 | ↑ | ↑ occasionally (usually <2-3×) |
Prothrombin time | ↑ | ± ↑ | Normal unless DIC/IUFD/abruption |
Alkaline phosphatase | ↑ | ± ↑ | ↑ occasionally |
Other | ↑ ammonia, very ↓ antithrombin III, ↓ platelets, ↓ fibrinogen, ↑ WBC, ↑ creatinine, proteinuria, ↓ glucose | + hepatitis serology, ↓ antithrombin III | Moderately ↓ antithrombin III, proteinuria, ↓ platelets, ↑ creatinine, ↑ uric acid |
Liver histopathology | Centrilobular microvesicular fat, Cholestasis | Marked inflammation and necrosis | Periportal fibrin deposits, hemorrhagic hepatocellular necrosis, inflammation |
Treatment | Immediate delivery, supportive | Supportive | MgSO4 seizure prophylaxis, delivery (delayed in very selected preterm cases), antihypertensive treatment |
| Cholestasis of pregnancy | Hemolytic uremic syndrome | Thrombotic thrombocytopenia purpura |
Onset (I/II/III trimester) | III, rare reports II | Any | Any, 60% <24 wk |
Clinical findings | Pruritus, (worst in PM, palms and soles), ± jaundice | Hypertension, acute renal failure, nausea/emesis, may have fever and neurologic findings, hallmarks are microangiopathic anemia and severe thrombocytopenia. | Often neurologic findings, fever and renal dysfunction, hallmarks are microangiopathic anemia and severe thrombocytopenia. |
Laboratory | | | |
Transaminases (U/mL) | ↑ (usually <300) | Usually normal | Usually normal |
Bilirubin (mg/dL) | Often ↑ (usually <5) | ↑ (unconjugated) | ↑ (unconjugated) |
Prothrombin time | Usually normal, may be ↑ | Usually normal | Usually normal |
Alkaline phosphatase | ↑ (up to 4 × normal) | Usually normal | Usually normal |
Other | ↑ serum bile acids | Normal antithrombin III, usually normal fibrinogen, ↓ WBC, ↓ platelets (often <20,000), significantly ↑ creatinine, ↑ uric acid, ↑ LDH, ± proteinuria | Normal antithrombin III, usually normal fibrinogen, ↑ WBC, ↓ platelets (often <20,000), normal – slightly ↑ creatinine, ↑ LDH, ± proteinuria, ↓ ADAMTS13 activity, + antiADAMTS13 antibodies |
Liver histopathology | Centrolobular cholestasis, no inflammation | Unknown | Unknown |
Treatment | Ursodeoxycholic acid, corticosteroids of reported benefit, vitamin K | For nondiarrheal associated HUS probably plasma exchange, FFP infusion, hemodialysis, ? corticosteroids/immunosuppressive agents | Plasma exchange, FFP infusion pending initiation of plasma exchange, ?corticosteroids/-immunosuppressive agents |