Unexplained Marked Elevation of Serum Transaminase Levels in the Third Trimester of Pregnancy, with Half of the Cases Suspicious of Intrahepatic Cholestasis of Pregnancy

설명되지 않는 임신 제3 삼분기 혈청 아미노전이효소 수치의 현저한 상승: 절반에서 임신성 간내담즙정체가 의심되는 증례들

Objective: Major causes of markedly elevated serum transaminase levels in the third trimester of pregnancy are severe preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet counts) syndrome, viral hepatitis, and so on. We have experienced cases in which we could not explain with usual causes. We presented the cases with a brief review of the literature. Methods: We collected cases with marked elevation of serum transaminase levels in the third trimester of pregnancy, and the exclusion criteria were the diagnoses of preeclampsia, HELLP syndrome, viral hepatitis, etc. We examined the characteristics and clinical courses of the cases. Results: We collected ten cases. Three patients had mild nausea or vomiting, and five had pruritus. Medians (ranges) of peak aspartate transaminase and alanine transaminase were 250 (112-497) IU/L and 348.5 (198-735) IU/L, respectively. Total bilirubin was mildly elevated in four cases. In liver ultrasound, four cases showed the findings of fatty liver. Gestational age at delivery ranged from 32 weeks 5 days to 37 weeks 6 days, and the mode of delivery was cesarean in seven cases. Rapid decreases in serum transaminase levels from around delivery were common findings. Conclusion: We have experienced unexplained cases with markedly elevated serum transaminase levels in the third trimester of pregnancy, and half of the cases are suspicious of intrahepatic cholestasis of pregnancy. In these cases, we suggest considering detailed history taking including pruritus and the determination of bile acid levels, with suspicion of intrahepatic cholestasis of pregnancy.

Objective: Major causes of markedly elevated serum transaminase levels in the third trimester of pregnancy are severe preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet counts) syndrome, viral hepatitis, and so on. We have experienced cases in which we could not explain with usual causes. We presented the cases with a brief review of the literature. Methods: We collected cases with marked elevation of serum transaminase levels in the third trimester of pregnancy, and the exclusion criteria were the diagnoses of preeclampsia, HELLP syndrome, viral hepatitis, etc. We examined the characteristics and clinical courses of the cases. Results: We collected ten cases. Three patients had mild nausea or vomiting, and five had pruritus. Medians (ranges) of peak aspartate transaminase and alanine transaminase were 250 (112-497) IU/L and 348.5 (198-735) IU/L, respectively. Total bilirubin was mildly elevated in four cases. In liver ultrasound, four cases showed the findings of fatty liver. Gestational age at delivery ranged from 32 weeks 5 days to 37 weeks 6 days, and the mode of delivery was cesarean in seven cases. Rapid decreases in serum transaminase levels from around delivery were common findings. Conclusion: We have experienced unexplained cases with markedly elevated serum transaminase levels in the third trimester of pregnancy, and half of the cases are suspicious of intrahepatic cholestasis of pregnancy. In these cases, we suggest considering detailed history taking including pruritus and the determination of bile acid levels, with suspicion of intrahepatic cholestasis of pregnancy.