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Liver disease in pregnancy
Liver diseases that are unique to pregnancy include intrahepatic cholestasis of pregnancy, preeclampsia/HELLP syndrome, and acute fatty liver of pregnancy. Viral hepatitis, autoimmune hepatitis, Wilson's disease, portal vein thrombosis, Budd-Chiari syndrome, and cirrhosis and portal hypertension are liver diseases that can occur during pregnancy but are not specific to pregnancy. Pregnancy does not generally worsen liver diseases but some conditions like autoimmune hepatitis and cirrhosis can be exacerbated during pregnancy, delivery, or postpartum. Treatment of liver diseases during pregnancy aims to continue standard therapies safely.
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Liver disease in pregnancy
- 1. Liver Diseases In Pregnancy PresentedBy-Dr Santosh M Narayankar Moderator-Dr G R Srinivas Rao
- 8. Liver Diseases UniqueTo Pregnancy • Intrahepatic Cholestasis of Pregnancy • Preeclampsia/HELLP Syndrome • Acute Fatty Liver Of Pregnancy
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- 21. Maternal risks afterdelivery • Increased incidence Of • Gall stones • Cholecystitis • Pancreatitis • Increased risk of cholestasis in subsequent pregnancy .
- 22. Acute Fatty LiverOf Pregnancy
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- 49. Liver Diseases NotSpecific to Pregnancy
- 50. Viral Hepatitis Viral hepatitis—causedby hepatitides A, B, C, D, or E; herpes simplex; cytomegalovirus; and Epstein-Barr virus—accounts for 40% of jaundice in pregnant women. Hepatitides A, B, and C have the same frequency in the pregnant and nonpregnant populations and during each of the three trimesters of pregnancy. Viral hepatitis does not appear to affect the pregnant state adversely; an exception to this is hepatitis E.
- 51. Autoimmune Hepatitis Reduced fertilityrate secondary to amenorrhea and anovulation. Can occur de novo during pregnancy or the postpartum period. Pregnancy can ameliorate autoimmune hepatitis, whereas delivery can exacerbate it. Clinically- Asymptomatic to an acute presentation with liver failure. Steroids and azathioprine are safe during pregnancy but birth defects have been described. Need careful monitoring during pregnancy and for several months postpartum.
- 52. Wilson Disease Pregnancy doesnot seem to have an adverse effect on the clinical course of Wilson disease. Recurrent abortions are common in untreated patients, which can be seen in 26% of cases. Untreated symptomatic women tend to suffer amenorrhea, oligomenorrhea, irregular menses, and multiple miscarriages. However, pregnancy is safe and successful when treatment with a chelating drug is continued uninterrupted. Zinc intake at a dose of 25 to 50 mg three times daily in pregnancy appears to be safe with very minimal teratogenicity.
- 53. Portal Vein Thrombosis PVTis a rare occurrence during pregnancy. No controlled studies of anticoagulation therapy in patients with acute PVT. Anticoagulation therapy in acute PVT is logical but still not firmly validated. Chronic PVT pts should be offered screening for varices. For varices, anticoagulation therapy should not be initiated until after adequate prophylaxis for variceal bleeding.
- 54. Budd-Chiari Syndrome Usually presentsin the last trimester or the puerperium. Treatment - No different from treatment used for nonpregnant BCS patients, except warfarin (FDA category X). LMWH at a curative dose should be started as soon as the diagnosis is established. Pharmacologic and endoscopic therapy for portal hypertension can be applied
- 55. Cirrhosis And PortalHypertension Worsening jaundice with progressive liver failure, ascites, and hepatic coma have been reported during the course of pregnancy in women with cirrhosis. Increased incidence of stillbirths, premature delivery, hypertension, and peripartum infection in women with cirrhosis especially when ascites is present. Sclerotherapy or endoscopic band ligation are successful in pregnant women with variceal hemorrhage. Prevention of variceal bleed in known cirrhotic who desires pregnancy is based on classic treatment with -blockers and/or endoscopic ligature. Prophylaxis with -blockers may be continued during pregnancy
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