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Transcript
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), • • • • • -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. • • • • 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. • • • • • • • • • • 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 • • • • Method of transmission : -blood, blood products. - sexual activity. - The virus can also be transmitted across the placenta. • • • • • • -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 • • • • • • • • • **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 • • • • • 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 • • • • • • • 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: – – – -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