HEPATIC CHANGES IN PREGNANCY

Plasma concentrations of g-GT, ALT, AST, and LDH are
high normal or slightly elevated and clinical signs of liver Disease like spider naevi and palmar erythema may occur
during normal pregnancy making diagnosis of liver disease
during pregnancy more difficult. Plasma concentrations
of alkaline phosphatase are increased 3-fold as a result
of placental production. Pregnant patients are more
likely to develop gall-stones as increased progesterone
concentrations cause a decrease in cholecystokinin
release and a reduction of the contractile response to
cholecystokinin. Succinylcholine may lead to prolonged
neuromuscular blockade secondary to a 25% fall in plasma
cholinesterase concentrations at term and a further 8% fall
three days postpartum (post delivery). This is compounded
by an increased volume of distribution at term but not
usually clinically significant. Never the less, standard or
increased doses of succinylcholine are recommended in
pregnancy. Succinylcholine sensitivity in females who are
heterozygote for an abnormal cholinesterase gene may
be unmasked due to a 25% decrease in hepatic protein
synthesis in pregnancy