Download الآثار الاجتماعية للعدوان الإسرائيلي على غزة

Acute fatty liver of pregnancy:
• -AFLP is a rare condition
• -unknown etiology
• -(although fetal long-chain
hydroxyacyl co-enzyme A
dehydrogenase (LCHAD)
deficiency).
• - It has an incidence in various studies of
between 1 in 7000 and 1 in 13 000
pregnancies.
• - It is frequently fatal for the mother and baby
unless there is a speedy diagnosis and the
correct treatment is given.
• Clinical manifestation :
• - an obese woman will present with
vomiting and a headache in her third
trimester.
• - She will quickly complain of malaise and
severe abdominal pain, followed by
jaundice and drowsiness.
• -50% of these women have symptoms of
pre-eclampsia (hypertension and
proteinuria),
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-the pre-eclampsia will mask the presentation of AFLP.
liver is tender but not enlarged
diagnosis:
-an ultrasound
-computerized tomography (CT) scan of the liver
demonstrates fatty infiltration. -Liver biopsy is
contraindicated owing to the risk of coagulopathy.
• -The liver enzymes are moderately raised and the
woman will also quickly show -renal failure (liver
function test )
• -blood glucose level (hypoglycemic.)
• Management :
• -correcting any coagulopathy : infusing fresh
frozen plasma.
• - The woman must be delivered immediately.
• -Caesarean section is said to have many
advantages for the baby, but it is safest for the
mother to birth vaginally if this is possible.
• - Epidural analgesia is contraindicated in all .
• -Convalescence is prolonged but usually
complete.
• -recurrence rate is low.
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Gall bladder disease •
-Pregnancy appears to increase the likelihood of
gallstone formation but not the risk of developing
acute cholecystitis.
Diagnosis of gall bladder disease is made by :
1-listening to the woman's previous history
2- an ultrasound scan of the hepatobiliary tract
or both.
- treatment of the biliary colic by:
• * analgesia, hydration, nasogastric
suction(compression ) and antibiotics.
• Surgery should be avoided if at all
possible.
Viral hepatitis: •
• Viral hepatitis is the most common cause
of jaundice in pregnancy.
• - Acute infection 1 in 1000 pregnancies
• - an incubation period of 1–6 months.
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Symptoms include :
-nausea
- Vomiting
- anorexia
- pain over the liver
- mild diarrhea
-jaundice lasting several weeks
-malaise.
- Fever is rare.
- the disease is asymptomatic, or mimics mild
influenza
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Method of transmission :
-blood, blood products.
- sexual activity.
- The virus can also be transmitted across
the placenta.
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-Hepatitis B :
-is more common in tropical and developing
countries.
-poor nutrition.
- limited use of contraception barrier)
-injecting drug users who share needles
-The more common infections are known as
hepatitis A, B ,C ,D and E
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**Hepatitis A (HAV):
-acute infection
-transmitted by ingesting water contaminated .
- It is endemic worldwide.
- Mother to baby transmission is rare but can occur
at birth.
- HAV is a self-limiting illness results in complete
recovery.
-Vaccination is available.
- Strict hygiene
-hand washing ,reduces the risk of cross infection
• Hepatitis B (HBV) :
• -serious infection.
• - 5–10% of those infected become
chronic carriers.
• - 25–30% of these will die.
• - 0.5–5% of the population are chronic
HBV carriers.
• - test for the HBV surface antigen
(HBsAg).
• - adults 90% cases of HBV resolve
completely within 1–3 months.
• -complications of HBV:
• transplacental passage of the virus and
through blood and body fluids at birth.
• 1-increased risk of chronic liver disease.
• 2-cirrhosis
• 3-primary liver cancer in later life.
• -Caesarean section does not prevent
mother to fetus transmission.
• Diagnosis :
• history of her symptoms and lifestyle.
• Serological studies, but it can be difficult to
distinguish hepatitis B from other forms of
viral hepatitis during the acute
presentation, before antibodies have
formed
• Treatment :
• Symptoms
• Infection control measures ,the woman is
considered to be infectious.
• Education about the disease, nutrition and
sexual advice, should be offered. -Liver
function will be monitored
• Assess fetal condition.
• Household contacts should be offered
immunization after their HBsAg was done .
• -Sexual partners should testing and giving
vaccination.
• Postnatally the mother will be encouraged to
accept vaccination for the baby. Breastfeeding is
permitted
Hepatitis C virus (HCV) :
risk factors for transmission
are blood and blood products.
the use of shared intravenous needles.
post-blood transfusion hepatitis
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HCV commonly from a blood donor
who had yet to sero-convert at the
time of blood donation
incubation period of 30–60 days
75% asymptomatic. In the remaining .
25% symptoms include transient
nausea and jaundice
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Complications ;
chronic HCV which is associated with B
cell lymphomas .
chronic liver disease.
(vertical) transmission from pregnant
women and placental the baby.
Type of birth normal .
breastfeeding safe.
No vaccine is available yet
Pregnancy and liver transplantation:
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-liver transplantation done before or during
pregnancy, many with successful outcomes.
-Although not desirable.
- liver transplantation in women of childbearing
age is becoming possible -women require expert
medical and midwifery care at a specialized
centre
Ready to deal with all of the
complications, both of a physical and
psychological nature
Thank you