This chapter describes the diagnosis, treatment, and prognosis for hepatocellular carcinoma (HCC) in pregnancy. Risk factors for HCC include hepatitis B virus (HBV) or HCV infections, aflatoxin exposure, cirrhosis, alcohol abuse, metabolic liver disease, carcinogen exposure, steroids, and male gender. There is a report of association between high parity, HBsAg carriers, oral contraceptives, and HCC. Detailed medical history and the level of serum alpha-fetoprotein (AFP) may be helpful as screening tools. Liver sonography and/or magnetic resonance imaging (MRI) together with fine liver aspiration are used for definitive diagnosis during pregnancy. These imaging methods and measures are also used for staging. Partial hepatectomy is the treatment of choice. The choice of aggressive approach is based on anatomical and surgical considerations, and tumor spread. Two case reports of HCC diagnosed in the second trimester reported favorable outcomes for both mother and child.