Pregnancy And Liver adenoma Management

Hepatocellular adenoma (HCA) in pregnant women requires special considerations
because of the risk of hormone induced growth and spontaneous rupture, due to
increased levels of steroid hormones during pregnancy that may threaten the
life of both mother and child. Most experts advocate that women with HCA should
not get pregnant or advise surgical resection before pregnancy. We recently
proposed not to discourage all women with HCA from pregnancy, based on a study
in which we monitored twelve women with documented HCA during a total of 17
pregnancies. In 4 cases HCA*s grew during pregnancy, requiring a Caesarean
section in 1 patient (2 pregnancies) and radiofrequency ablation in 1 case
during the first trimester of pregnancy. All pregnancies had an uneventful
course with a successful maternal and fetal outcome. However, there is no
evidence-based algorithm for the evaluation and management of HCA during
pregnancy, due to scarcity of cases. The conclusion not to discourage all women
with HCA from pregnancy has, however, to be proven in a large multicentre study
in which we will closely monitor pregnant patient with a HCA in a prospectively
acquired database to give more insight in the behaviour of HCA during
pregnancy.

In this study we will investigate the management of HCA during pregnancy based
on a prospectively acquired online database in the Netherlands.

In this study we will investigate the management of HCA during pregnancy based
on a prospectively acquired online database in the Netherlands. The PALM-study
is a multi-centre prospective case-control study.

Study group
Properly Dutch speaking, pregnant patients, 18 years of age or older with a
radiologically (MRI with liver specific contrast agent) and/or histologically
proven diagnosis of HCA can be included in the study. Radiological diagnosis of
HCA will be based on contrast enhanced magnetic resonance imaging (pre- or
postpartum). Lesions must not exceed 5 cm. These patients have an indication
for pregnancy care at obstetrician in secondary care.

In the first weeks of pregnancy patients will be referred to the obstetrician
for pregnancy care. Baseline starts at 14 (+/- 3) weeks of gestation. At this
day and every 6 weeks patients will undergo ultrasound (US) of the HCA lesion
at the hepatologist and patients will, if possible, undergo a venapunction at
14 and 32 weeks of pregnancy. Before US of the HCA lesions and 2 days
afterwards patients will be asked to fill out the Shortform 36 (SF-36)
questionnaire.

Patients will experience minimal impact of this study, without additional
risks. The study takes time from the patient.