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Cholestasis of pregnancy recurs in 60 to 70 percent of subsequent pregnancies.3 Preeclampsia Hepatic dysfunction with preeclampsia has long been recognized.22 More recently, this dysfunction has miss plump been associated with other findings miss plump in the HELLP syndrome. This syndrome may complicate the course in 3 to 10 percent of patients with preeclampsia and is noted in 0.1 percent of all pregnancies.23,24 The pathophysiology of HELLP syndrome reflects that of preeclampsia, with microvascular damage, platelet miss plump activation and vasospasm. Liver biopsy reveals periportal hemorrhage and fibrin deposition.25 Recent data suggest that a defect in nitric oxide metabolism may contribute to preeclampsia and HELLP syndrome.26,27 Notable hepatic abnormalities in the HELLP syndrome include hemolysis (with elevated bilirubin levels and lactate dehydrogenase levels greater than 600 IU per L), moderately elevated transaminase levels (AST and ALT levels of 200 to 700 IU per L) and a platelet count less than 100,000 per mL (100 × 109 per L).2,3
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