Perinatal Management of Hepatic Adenomas.

IMPORTANCE: With a strong association between hepatic adenomas and estrogen established, understanding the risks, evaluation, and perinatal management of hepatic adenomas is necessary for obstetric clinicians. OBJECTIVE: The aim of this study is to review the preconception counseling, perinatal management, and postpartum care of hepatic adenomas. EVIDENCE ACQUISITION: A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines. RESULTS: Hepatic adenomas require individualized recommendations based on their prepregnancy size and evolution over pregnancy. Hepatic adenomas measuring greater than 5 cm are associated with a significantly increased risk during pregnancy including rupture. Ideally, optimal management of hepatic adenoma includes accurate diagnosis, discontinuation of estrogen-containing contraception, and surgical resection of large masses prior to conception. Patients should undergo serial surveillance of the adenoma during the antenatal and postpartum periods, with surgical intervention as indicated with multidisciplinary planning. CONCLUSIONS AND RELEVANCE: An individualized approach is necessary when managing hepatic adenomas in the patient who is pregnant or intends pregnancy. More contemporary data are required to guide management and patient counseling.

Duke Scholars

Author Jeffrey Adam Kuller Obstetrics and Gynecology, Maternal Fetal Medicine

Author Carla Wheaton Brady Medicine, Gastroenterology