Title: Non Pathological Increase of Serum Liver Enzymes during Puerperium
Authors: Dr P.Guru Sankari, Dr K. Lavanya Kumari, Dr S.Sethupathy
DOI: https://dx.doi.org/10.18535/jmscr/v4i11.48
Background: Measurement of liver function in pregnancy and puerperium is very important as the diagnosis and management of a number of potential complications such as pre-eclampsia, syndrome of haemolysis, HELLP syndrome (elevated liver enzymes, and low platelets), acute fatty liver of pregnancy and obstetric intrahepatic cholestasis depends on proper estimation of liver function tests (LFTs). All these conditions may occur for the first time in pureperium or deteriorate in the puerperium. This study was carried out at Rajah Muthiah Medical College, Chidambaram to assess the liver function tests in the puerperium in uncomplicated pregnancies. Materials and Methods: Ninety (90) antenatal women with gestational age between 37 & 40 weeks who delivered without any antenatal complication were selected in this prospective study. Information was collected after detailed history taking and complete physical examination. Blood samples were collected for liver function tests just before delivery, 48 hours after delivery (day 2), on day 5 and on day 10. Statistical analysis of the results of LFT values was done using ANOVA test. Results: There was 10% increase in serum AST levels after delivery on Day 2 and another 9% on Day 5 in comparison to antenatal period and it dropped back to pre-delivery levels on day 10. There was 9% increase in serum ALT levels after delivery on Day 2 and 11% on Day 5 in comparison to antenatal period and on 10th day it dropped back to pre-delivery levels. There was 14% increase in serum ALP levels after delivery on day 2 and 16% on day 5 in comparison to antenatal period and on 10th day there was only 10% drop from day 5 levels and did not reach the pre-delivery levels. Other parameters like total protein, serum albumin and globulin, total bilirubin and direct bilirubin were unaffected. Conclusion: Only the transaminase levels (AST and ALT) and alkaline phosphatase levels were significantly higher after delivery on day 2, 5 and declined to pre-delivery levels by post-operative day 10 except for alkaline phosphatase. These findings should be kept in mind while interpreting the liver function test results in the immediate post-partum period. If the enzyme levels remain raised even after 10 days into post-partum period, it may be a warning sign of underlying liver dysfunction. Keywords: Liver Function Tests (LFT), Non pathological Puerperium. 1. Friedman LS, Maddrey WC; Surgery in the patient with liver disease. Med Clin North Am.1987;71(3):453. 2. Corton MM, Leveno K, Bloom S, Hoffman B. Williams Obstetrics 24/E (EBOOK). McGraw Hill Professional; 2014 May 6. 3. David, A. L., Kotecha, M. and Girling, J. C. (2000), Factors influencing postnatal liver function tests. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 1421–1426. 4. Strunin L. Anesthetic management of patients with liver disease. In: Millward-Sadler GH, Wright R, Arthur MJP, eds. Wright’s Liver and Biliary Disease. London: Saunders 1992; 1381-1393. 5. Cowan RE, Jackson BT, Grainger SL, Thompson RPH. Effects of anesthetic agents and abdominal surgery on liver blood flow. HEPATOLOGY 1991; 14:1161-1166. 6. Batchelder BM, Cooperman LH. Effects of anesthetics on splanchnic circulation and metabolism. Surg Clin North Am 1975;55:787-794. 7. Ngai SH. Effects of anesthetics on various organs. N Engl J Med 1980;302:564-566 8. Ropponen A, Sund R, Riikonen S, Ylikorkala O, Aittomäki K. Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diease: A population-based study. Hepatology. 2006;43:723–8. 9. Lata I. Hepatobiliary diseases during pregnancy and their management: An update. International journal of critical illness and injury science. 2013 Jul;3(3):175. 10. Adeniyi FA, Olatunbosun DA. Origins and significance of the increased plasma alkaline phophatase during normal pregnancy and preeclampsia. Br J Obstet Gynaecol.1984;91(9):857–862 11. Valenzuela GJ, Munson LA, Tarbaux NM.et al. Time-dépendent changes in bone, placental, intestinal, and hepatic alkaline phosphatase activities in serum during human pregnancy. Clin Chem. 1987; 33(10):1801–1806.Abstract
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