Pregnancy with liver disease is a relatively common condition in pregnant women, but it is also a high-risk maternal category, as is pregnancy in patients with cardiac disorders. Usually, due to normal pregnancy, liver disease can have certain physiological changes, and when pregnancy has significant complications, dramatic vomiting, pre-eclampsia, and eclampsia can cause liver damage. Pregnancy can also induce certain specific liver diseases, such as intrahepatic cholestasis in pregnancy, acute fatty liver, etc. The most important thing that cannot be ignored is the “hepatitis patient base” in China, when they reach the age of marriage, pregnancy adds to their liver inflammation …… but whatever the cause, pregnancy combined with liver disease or liver disease based on pregnancy, have enhanced maternal consumption, prone to cause abortion The most important thing is that it is easy to get a good idea of what to expect. Therefore, liver disease in the middle and late stages of pregnancy tends to be severe, with high maternal and infant mortality rates. Due to the objective historical reasons and the unbalanced medical layout and level of medical care, it is extremely inconvenient to seek medical consultation for liver disease in pregnancy. Especially in rural areas, many general hospitals or maternal and child health institutions do not have infectious disease departments or liver disease specialists, and those hospitals with infectious disease departments or liver disease specialists lack obstetrics and gynecology and neonatal wards, which makes diagnosis, treatment and follow-up extremely difficult. Therefore, it is extremely necessary to establish a perfect and standardized system (institution) for diagnosis and treatment of liver disease in pregnancy, and to conduct rigorous research and study on the diagnosis, differential diagnosis and treatment (including delivery methods) of patients, in order to reduce mortality and ensure the well-being of mothers and infants. I. Diagnosis and differential diagnosis The early diagnosis of liver disease in pregnancy is important, whether it is pregnancy-related liver disease or combined liver disease in pregnancy. After admission, the hepatology and obstetrics and gynecology departments will consult together, analyze the examination results and data, make the final diagnosis and choose reasonable treatment, and decide whether to keep the fetus or not and determine the delivery plan. The literature reports that the prognosis of liver disease in early pregnancy is generally good, but that of liver disease in mid- to late-term pregnancy is relatively severe and the prognosis is poor. The prognosis of liver disease in mid- to late-stage pregnancy is generally good, but the prognosis of liver disease in mid- to late-stage pregnancy is relatively severe and poor, and viral hepatitis accounts for about 60% of liver disease in mid- to late-stage pregnancy. Early definitive diagnosis is the key to a good prognosis, and those that are temporarily difficult to diagnose must be judged under strict clinical observation measures, as fetal monitoring, as close observation, and according to strict procedures, with a view to early clarification. Of course some definitive diagnoses require time and surgery, biopsy, etc. We have seen a patient with liver damage in pregnancy who had hemorrhage during labor and delivery, and the diagnosis was confirmed by cesarean exploration and liver tissue biopsy as a result of ruptured hepatic hemangioma with cervical adhesions; another pregnant patient diagnosed with severe hepatitis was diagnosed with biliary hepatitis by liver tissue biopsy during cesarean delivery. Second, the diagnostic significance of ALT, BIT, albumin and PT The elevated ALT level in pregnant patients with liver disease is a common feature. The p-values of ALT and AST results grouped in the hepatitis or non-hepatitis groups were processed with p-values greater than 0.05, so there was no significant difference. Therefore, the diagnostic significance of both in hepatitis and non-hepatitis pregnancies is poor, which is one of the reasons for the clinical difficulties brought about by enzymatic diagnosis alone. In terms of bilirubin level, although there is some difference between hepatitis and non-hepatitis pregnant patients, hepatocellular jaundice, BIT tends to be higher, except for the differentiation from pregnancy biliousness, which is still difficult, there are generally no special problems, and the bilirubin in the hepatitis pregnancy group and the non-hepatitis pregnancy group is statistically processed, p<0.05, so there is a significant difference in the bilirubin level between the two groups. If the increase in bilirubin is then referred to the PT value, a preliminary diagnosis and prognosis of severe hepatitis can be made. This is a reference value for the timely formulation of whether to terminate the pregnancy immediately and in what way. Decrease in albumin is seen in normal pregnancy, but its decrease is generally less than 5%. From the statistical results of protein changes in the hepatitis pregnancy group and the non-hepatitis pregnancy group, p<0.01, there is a very significant difference, and a significant decrease in ALB is a significant feature in patients with all types of hepatitis pregnancy. Therefore, dynamic observation of albumin must be intensified and the magnitude of its decrease must be followed. Prothrombin time, as an objective indicator, can be used to determine the condition of liver coagulation and the prognosis of liver disease, similar to hepatitis in non-pregnancy, where hepatocyte reserve and synthesis are significantly reduced, which has a great impact on the prognosis of the birth. This value can be converted to prothrombin activity and is more meaningful if referred to the fibrin principle. The PT is prolonged by bilirubin. In the process of medication, we try to avoid aromatic dryness, dampness, heat, blood circulation and siltation to prevent bleeding and premature delivery. In the postpartum period, we use warm tonic, blood invigorating and anti-yellowing products as appropriate to strengthen the support and care for the liver and the whole body. Patients with liver disease in pregnancy often have elevated transaminases as the main manifestation, so diammonium glycyrrhizate or hepatitis lucidum injection to lower enzymes is used as the main routine medication. However, the follow-up and monitoring of the population including the subsequent pending delivery and the postpartum period is enhanced through the close observation that we believe is necessary. The relationship between the mode of delivery and prognosis: through the observation of the analysis of clinical symptoms and objective examination indicators in patients with liver disease in pregnancy, natural delivery should be the best choice when fetal development allows. However, in the case of further damage to liver function, impaired coagulation mechanism, decreased liver and kidney function, and poor general condition, which endangers the life of the fetus and mother and child, termination of pregnancy, becomes a priority, and whether to terminate the pregnancy immediately and in what way must depend on the situation. In general, the fetus depends on the mother for respiration and excretion; the caloric demand of the pregnant woman increases suddenly, and the demand for protein, vitamins and essential elements increases; the secretion of various sex hormones hinders the operation of the liver for fat and bile excretion; the pregnant woman is nervous and hungry during delivery, and the secretion of adrenaline increases, and the glycogen reserve decreases; at this time, bleeding, anesthesia and other factors can further aggravate liver damage. Objectively speaking, cholestasis of pregnancy is likely to cause premature delivery and postpartum hemorrhage, making the fetus premature and intrauterine distress; acute fatty liver poses the greatest threat of death to mother and child; pregnant women with cirrhosis are very prone to hemorrhage, postpartum hemorrhage, and make the fetus abort, prematurely deliver or die; pregnant women with chronic active hepatitis are very prone to transform into heavy hepatitis, and the risk of premature fetal death cannot be ignored; as for toxemia of pregnancy, uterine rupture, etc. unless mastering The mortality rate of mother and child will also increase unless the indications for early cesarean delivery are known. Therefore, it is important to have a good understanding of the mode of delivery. However, theoretically, most physicians hold the view of "safe and secure" that spontaneous delivery should be performed, except in rare cases of severe disease. However, in view of the development trend of liver disease patients, continuing pregnancy will not improve the function of the liver, but will further increase the burden on the liver, sharply decrease the protein glycogen reserve, seriously impair the coagulation mechanism, and irreversibly damage the liver, endangering the life of both mother and child. It would be a pity to wait for a natural childbirth at this time, if you are afraid to take the risk of surgery for "safety and security". There is no unified model or standard for the termination of pregnancy, and the choice must be made based on the changes in the condition, the degree of liver damage and the condition of the fetus in the uterus, based on close observation of the condition. If a cesarean section is performed, the uterus should even be prepared to be removed, which is the best practical choice. The clinical diagnosis of liver disease in pregnancy must be improved by strict diagnostic procedures and the joint efforts of hepatologists and obstetricians and gynecologists. In the management of severe liver disease in pregnancy, it is better to be aggressive than to wait conservatively; timely termination of pregnancy by cesarean section, based on enhanced medical support, can help to reduce mortality and improve maternal and infant survival rates, but there are many debatable issues. When the clinical differentiation between acute fatty liver in pregnancy and severe hepatitis in pregnancy is still difficult, liver biopsy is necessary, in addition to the determination of viral indicators, early examination by CT and ultrasound and analysis of clinical features. However, liver biopsy is difficult and controversial in patients with high bilirubin, significantly prolonged prothrombin time and decreased activity. Many data after percutaneous liver puncture in patients with perinatal liver disease suggest that the overall compliance rate of initial diagnosis confirmation before liver puncture is 61.24%, and increases to 90.69% after liver puncture. However, some data suggest that the pathological specificity of liver disease in pregnancy is poor, and the diagnosis must be closely combined with clinical data. After all, liver puncture is invasive and should not be performed universally unless it is specifically needed, and the pathology of liver disease cannot distinguish the etiology of hepatitis, and neither light nor electron microscopy is ideal for suggesting ICP. If clinical information is combined with medical history and signs as well as observation of liver morphology during cesarean section, it will be more beneficial to improve the diagnostic conformity rate.