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144 Liver disease in pregnancy

144 Liver disease in pregnancy

Authors :
Felipe Favorette Campanharo
Coni Waldow
Nelson Sass
Livina Silva Souza
Rosiane Mattar
Sue Yazaki Sun
Antonio Fernandes Moron
Jose Ferreira Silva Neto
Source :
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 6:251
Publication Year :
2016
Publisher :
Elsevier BV, 2016.

Abstract

Introduction After caring of some patients with liver disorders in pregnancy we decided to review the main differential diagnosis of preeclampsia (PE) and liver disease. Objectives A quick review of the liver diseases related to pregnancy. Methods 2 case reports and a Pubmed review in recent years of the main differential diagnosis of PE. Results : Case 1: Pregnant 33 weeks gestation due to fever, myalgia, heartburn, vomiting, edema, jaundice (J), normal blood pressure (BP) and the following abnormal laboratory tests: leukocytosis, C-reactive protein, direct bilirubin (3.5 mg/dL), alanine aminotransferase (ALT) (643U/L), aspartate aminotransferase (AST) (421U/L), creatinin (C) (1.4 mg/dL), urea, coagulopathy and hypoglycemia (54 mg/dL). After 3 days, evolves with renal and hepatic insufficiency and underwent cesarean section (CS) and it was necessary treatment for atonia uterine. The patient received fresh frozen plasma, cryoprecipitate, packed red blood cels and intensive care (IC). Both, patient and newborn, home discharged in good health. Case 2: Pregnant 30 weeks of gestation complaining of itching and dark urine beginning 2 months earlier. Admitted at the hospital with J, elevation of ALT, AST, bilirubin, C and proteinuria. After 48 h of corticosteroids the patient was submitted to CS and had worsened renal and hepatic function. Liver biopsy was performed. HELLP syndrome The association of hemolysis, low platelet counts (PLTs) and elevated liver enzyme levels (LEL) is known by HELLP syndrome (SD). Occurs in about 0.5–0.9% of all pregnancies and complicates 10–20% of cases with severe PE, but some have the SD without hypertension. In 70% occurs in ante partum, in the third trimester. The symptoms are nausea, vomiting, epigastric and right upper quadrant abdominal pain. The pathogenesis is still a mystery; the association with PE supports the theory of deficient trophoblastic invasion causing inflammation and endothelial dysfunction. The treatment is delivery and IC. Acute fatty liver of pregnancy Acute fatty liver of pregnancy (AFLP) is a rare condition characterized by microvesicular steatosis associated with mitochondrial dysfunction that occurs mostly in the third trimester. Nausea, malaise, abdominal pain, J, fever, pruritus, hypertension, headache, coagulopathy, ascites, hypoglycemia and rarely encephalopathy are the symptoms. Effective treatment depends on how earlier is the resolution of pregnancy and IC. The patient generally improves from hepatic and renal failure and recovery in most cases within a few days. Intrahepatic cholestasis of pregnancy Intrahepatic cholestasis of pregnancy (ICP) is a dysfunction, mostly in the third trimester, of bile acid (BA) transport across the canalicular membrane that results in systemic accumulation of BA with intense pruritus. The pathogenesis is unknown but involves a genetic hypersensitivity to estrogen (E) or E metabolites. ICP has a benign prognosis to women but a higher risk of the fetus. The treatment is with symptomatic relief for the mother, supervision of the fetus, ursodeoxycholic acid and delivery. Conclusion The similar symptoms of hepatic diseases in gestation often lead to a retrospective diagnosis. However the resolution of pregnancy and an IC of patients with HELLP SD, AFLD and ICP generally is the main form of treatment. The first case diagnosis was AFLD and the result of the biopsy in the second case was ICP. Finally, we would like to thank the support of our Intensive Care Unit and Gastroenterology teams at UNIFESP.

Details

ISSN :
22107789
Volume :
6
Database :
OpenAIRE
Journal :
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
Accession number :
edsair.doi...........899f69239ad037fe19de1051513691fb
Full Text :
https://doi.org/10.1016/j.preghy.2016.08.226