Pregnancy and liver disease.
42 - 58.
Liver disease in pregnancy should be considered in 3 categories: pre-existing disease, disease peculiar to pregnancy and coincident acute liver or gall-stone disease. In addition the time of onset of diagnosis in terms of the trimester of gestation must be verified, as the diseases peculiar to pregancy have a characteristic time of onset. In the last trimester closes obstetric management is required for the constellation of abnormal liver function tests, nausea and/or vomiting and abdominal pain. This may be due to severe pre-eclampsia, HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome or acute fatty liver of pregnancy with or without sub-capsular hepatic haematomas, amongst which there is an overlap. Early delivery is curative. A molecular basis consisting of long chain 3-hydroxyl CoA dehydroxegenase deficiency in heterozygote mothers underlies this clinical syndrome. Ursodeoxycholic acid is now established treatment for intra-hepatic cholestasis of pregnancy and appears to improve foetal outcome. Hepatitis B vaccination and immunoglobulin at birth prevents chronic hepatitis B in children of HBsAg (hepatitis B surface antigen) positive carrier mothers.
|Title:||Pregnancy and liver disease.|
|Keywords:||3-Hydroxyacyl CoA Dehydrogenases, Abdominal Pain, Acute Disease, Child, Cholagogues and Choleretics, Cholelithiasis, Delivery, Obstetric, Fatty Liver, Female, Gestational Age, HELLP Syndrome, Hematoma, Hepatitis B Surface Antigens, Hepatitis B Vaccines, Hepatitis B, Chronic, Heterozygote, Humans, Liver, Liver Diseases, Nausea, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Pregnancy Trimester, Third, Ursodeoxycholic Acid, Vaccination, Vomiting|
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