Liver Disease In Pregnancy

A liver disease during pregnancy may be pre-existing restricted be the same occur with pregnancy and possibly aggravated by the pregnancy jaundice on the pregnancy Jaundice (jaundice) may be due to a non-obstetric or obstetric disease. Among the pregnancy unrelated causes include acute viral hepatitis (most common) drugs Acute cholecystitis bile duct obstruction in gallstones gallstones seem to form during pregnancy more often, probably because the Lithogenität bile increased and the contractility of the gall bladder is impaired. To dengynäkologischen causes (a slight jaundice usually causes) include hyperemesis gravidarum septic abortion Both cause liver damage and hemolysis. Acute viral hepatitis, the most common cause of jaundice during pregnancy is an acute viral hepatitis. Pregnancy does not affect the course of most viral hepatitis (A, B, C, D); Hepatitis E, however, can worsen during pregnancy. An acute viral hepatitis can cause premature birth aspirations, but does not seem to teratogenic. The hepatitis B virus is often transmitted transplacental immediately after birth to the newborn or what happens more rarely on the fetus. A transfer is especially likely if pregnant women are e-antigen positive and chronic carriers of the hepatitis B surface antigen (HBsAg), or if they have contracted the hepatitis during the third trimester. The affected newborn infants are more likely to subclinical hepatic dysfunction, and they will be more support than they develop a clinically manifest hepatitis. All pregnant women are tested for HBsAg to detect whether preventive measures against vertical transmission are required (prenatal prophylaxis with immunoglobulin and vaccination of newborns with hepatitis B virus Kontak- hepatitis B virus (HBV) infection in newborns :.. prevention; editor’s note .: in Germany part of prenatal care). Chronic hepatitis Chronic hepatitis, especially with liver cirrhosis, impaired fertility. When it comes to pregnancy, there is an increased risk of spontaneous abortion and premature birth, but no increased risk of maternal mortality. Despite standard immunoprophylaxis many infants born to women infected with high viral load with the hepatitis B virus. The available data suggests that antiviral Azneimittel that are given during the third trimester to prevent a failure of the immune prophylaxis. Fetal exposure should be minimized by the fact that antiviral Azneimittel be given only in women with advanced hepatitis or at risk for liver failure. Lamivudine, telbivudine or tenofovir disoproxil fumarate are most commonly used. Corticosteroids, which were given before pregnancy for the treatment of chronic autoimmune hepatitis can be taken further during pregnancy because of fetal risks do not seem to be higher by corticosteroids than those made by the maternal chronic hepatitis. Azathioprine and other immunosuppressive agents are sometimes indicated regardless of the fetal risks associated with threatening disease. Intrahepatic of pregnancy (-pruritus) This relatively common disease apparently results from an increased sensitivity to the normal, due to hormonal changes biliary stasis. The frequency depends on the ethnicity and is highest in Bolivia and Chile. Consequences are an increased risk of fetal prematurity, stillbirth and respiratory distress syndrome. During the 2nd or 3rd trimester, a more intense itching developed as the earliest symptom; sometimes followed by dark urine and jaundice. Acute pain and systemic symptoms are absent. Mostly the disease sounds after birth, but it tends in every pregnancy or oral contraceptive use for else recurrent. The disease is suspected because of symptoms. The most sensitive and specific laboratory finding is a total fasting serum bile acid value of> 10 mmol / l. This finding can possibly be changed as the only laboratory value. Fetal death is more likely in a fasting total bile acid value of> 40 mmol / l. Agent of choice is ursodeoxycholic acid (UDCA) 5 mg / kg p.o. 2 times / day or 3 times / day (or up to 7.5 mg / kg 2 times / day). It reduces the severity of symptoms and normalizes liver function, but it does not reduce the incidence of fetal complications. Fatty liver of pregnancy This rare, has been little clarified disease occurs near term, sometimes with preeclampsia. The patients can have an inherited defect in the mitochondrial fatty acid ?-oxidation (which provides the energy for the skeletal and cardiac muscles are available); the risk for fatty liver of pregnancy is 20 times higher in women with a mutation of the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), especially in the presence of the mutation G1528C in one or both alleles (autosomal inherited). Symptoms include acute nausea and vomiting, abdominal pain and jaundice, and in some cases threatening followed by a rapidly progressive hepatocellular failure. In severe cases, the mortality rate for both mother and fetus is high. A seemingly identical disease can develop at any stage of pregnancy when high doses of tetracycline i.v. are given. The clinical and laboratory findings similar to those of fulminant viral hepatitis, except that most of the aminotransferase levels are elevated to <500 I.E./l and hyperuricemia is. The diagnosis is made by clinical criteria, liver function tests, tests for hepatitis serology and from a liver biopsy. The biopsy shows in the hepatocytes diffusely distributed microvesicles of fat, usually with tiny Nekrosezeichen, but in some cases, the findings do not differ from those of viral hepatitis. Affected women and their children should be tested for known genetic variants of LCHAD. Depending on gestational age, either immediate delivery or termination of pregnancy is recommended, although it is unclear whether there is a slightly altered by both measures on the course for the mother. Survive the patients, they recover completely and do not experience recurrences. Preeclampsia A strong pre-eclampsia (pre-eclampsia and eclampsia) can lead to liver problems with fibrin, necrosis and bleeding and cause abdominal pain, nausea, vomiting and a slight jaundice. occasionally occurs a subcapsular hematoma with intra-abdominal bleeding, it was mostly in pregnant women with pre-eclampsia, which is the HELLP syndrome (hemolysis, elevated liver enzymes and thrombocytopenia [low platelet count]) developed. Rarely, while a spontaneous, life-threatening liver rupture; The pathogenesis is unknown. Chronic liver disease Pregnancy can with primary biliary cirrhosis and other diseases associated with cholestasis, temporarily impair the cholestasis, and increased plasma volume during the third trimester increases for pregnant women with cirrhosis the risk of variceal bleeding slightly. Nevertheless usually not harmful to women with chronic liver disease of pregnancy. A cesarean section is reserved for the usual obstetric indications.

Health Life Media Team

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