The liver in pregnancy

During pregnancy in healthy women there is a change in the liver as a result of changes in general hemodynamics in this condition. In this nine-month period there was an increase in total blood volume and plasma of 1700-1900 ml, which naturally results in a change of blood flow through the plasma and some internal organs, which also leads to changes in the level of coagulation and to the terms of hypercoagulability . Changes in liver size in healthy pregnant women do not notice, but in the main laboratory findings are changes such as increased alkaline phosphatase, cholesterol, triglycerides, fibrinogen, leukocytes, while urea, uric acid and hemoglobin in the fall.

These changes in liver function in healthy pregnant women are withdrawn from the end of pregnancy. However, pregnancy can cause permanent liver disease or alter the course of existing disease.

The most common liver disease in pregnancy develops in pre-eclampsia and eclampsia, although the resulting illnesses that may not be etiologically related to them.

HELLP syndrome occurs in 5-15% of pregnant women with preeclampsia. Changes related to liver are manifested in terms of hemolytic anemia, increased activity of liver enzymes, low platelet values, which are called by the disease (Hemolytic anemia, Elevated Liver enzymes, Low Platels) with of course the occurrence of symptoms of eclampsia and other causes of headache, edema, hypertension, proteinuria, nausea and vomiting, hepatosplenomegaly, and laboratory bilirubinaemia and increased aminotransferases.

Vomiting in pregnancy is manifested by a large number of pregnant women, especially in the first trimester of pregnancy. Resolved spontaneously and requires the adequate rehydration therapy, only pregnant women.However, the small number of cases it becomes excessive vomiting, dehydrated and pregnant women, in a mineral imbalance that can result in damage to the fetus. The laboratory findings of these pregnant women is bilirubinaemia, increased aminotransferase values, changes in hormonal status in terms hepertireoze, and this symptom can not be ignored, or wait for its spontaneous regression. Proper treatment in hospitals in most cases the pregnancy can continue without consequences on the health of the fetus.

Acute fatty infiltration of the liver in pregnancy is a severe disease of the liver that can occur in isolation as part of pre-eclampsia. In this disease present with clinical symptoms of preeclampsia and HELLP syndrome symptoms, occurring and diabetes insipidus. The disease manifests in repeated pregnancies and women with children from these pregnancies, and therefore believes that this is probably heredity in terms of insufficient oxidation of fatty acids.

Liver infarction and spontaneous rupture of liver disease is rare in pregnancy, as part of eclampsia, which occurs most commonly as a consequence of hypercoagulability. Spontaneous rupture occurs suddenly, often in the left lobe and very rarely has a good prognosis.

Cholestasis during pregnancy manifested pruritus of the skin that occurs at the beginning of pregnancy, then the occurrence of slight yellowing of the skin, as well as increasing the gallbladder. The laboratory is accompanied by increasing values ​​of aminotransferases, γ-GT, the values ​​of bile acids and copper. The therapy can be used antihistamine, but everything stops until the end of pregnancy. The disease is so dangerous for a pregnant woman as the result, because it can leave the consequences to normal fetal development and result in an increased number of stillbirths and premature infants.

So far, the above mentioned diseases of the liver occur in pregnancy in healthy pregnant women, and therefore a healthy liver. Now we are going to say something more about the deterioration of the existing liver disease, and that pregnancy worsens and causes numerous effects in the mother and the fetus.

Pregnancy and viral hepatitis

When a pregnant woman suffers an acute infection with hepatitis B, usually the most difficult stage of the disease occurs and therefore does not come to an increased infant mortality or an increased number of newborns with congenital malformations. Vaccination during pregnancy has no consequences on the fetus. In pregnant women with chronic hepatitis B or female hens hepatitis B virus activation or egzarcerebracija disease does not occur frequently. The most important is prevention, so called. "Vertical" transmission from mother to child, which occurs most frequently in HBeAg-positive mothers with high values ​​of HBV-DNA in serum. Also, it is necessary to implement immunoprophylaxis for all newborn babies whose mothers are carriers of hepatitis B virus. Pregnant women with chronic hepatitis C usually have no major complications in pregnancy and the possibility of transmission to the child who is less than hepatitis B.

Pregnant women with chronic autoimmune hepatitis who were treated with immunosuppressants, too, have hardly any reactivation of the disease. They can be treated with small doses azatriopina.

Larger percentage of the risk of preeclampsia, and birth of a child with a maliformacijama of the patients diagnosed with biliary cirrhosis, Wilson's disease porphyria, or some form of hyperbilirubinemia.

It should be remembering that due to decreased motility of gallbladder disease and hypercholesterolemia frequently in pregnancy, as well as deterioration occurs in patients with cholelithiasis. Treated conservatively, except in exceptional cases should be dealt with surgically.

References:

Michielsen PP, Van Damm P. Viral hepatitis and pregnansy. Aca Ggastroent. Belg 1999; 62:21

Barton J, Sibai B Hematic imaging in HELLP syndrome: hemolisysis elevated liver enzymes and low platelet count.Am J Obstet Gynecol 1996; 174:1280

Colic-Cvrlje V liver in pregnancy. Internal medicine Vrhovac et al Forward Zagreb 1997, 1032

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