Book of Medical Disorders in Pregnancy - Tintash

highest reported rate of vertical transmission
in this group occurs in infants
born to hepatitis C virus positive, HIV
positive mothers, with transmission rates
of 6 to 36 percent. No therapy has been
shown to influence neonatal
transmission of hepatitis C virus.
Vertical transmission of the virus has
been reported to occur in two of three
infants of mothers with acute hepatitis C
virus infection, suggesting a higher risk
of vertical transmission than occurs in
patients with chronic infection, secondary
to the high levels of hepatitis C
virus RNA that occur in acute infection.
Interferon therapy should not be
administered during pregnancy because
of its possible adverse effects on the
fetus.
Cholelithiasis in pregnancy:
Cholelithiasis is noted in as many as 6
percent of pregnant women. Pregnancy
induced changes in bile composition predispose
these patients to cholelithiasis.
Cholestasis during pregnancy:
The bile salt pool decreases in the
second trimester, and biliary cholesterol
levels may increase, resulting in
lithogenic bile. In addition, gallbladder
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emptying slows in the second trimester,
increasing the risk of cholelithiasis. Surgical
treatment of biliary colic is safely
accomplished in the first and second
trimesters but should be avoided in the
third trimester. Symptoms of cholelithiasis
are similar in pregnant and non
pregnant patients. Patients with
cholecystitis typically present with laboratory
abnormalities, including
leukocytosis and mild to moderate
elevations of transaminase and bilirubin
levels. The alkaline phosphatase level
progressively increases during normal
pregnancy and is unhelpful in
distinguishing hepatobiliary disease. A
liver ultrasound examination is most
helpful in determining the presence of
chole-lithiasis or sludge in symptomatic
patients.
Surgical treatment (i.e., laparoscopic
cholecystectomy) of biliary colic can be
safely accomplished in the first or second
trimester. As the uterus enlarges,
surgery becomes more difficult and should
be avoided during the third trimester.
A retrospective review 17 of 19,000
pregnancies revealed that 11 percent of
surgical emergencies were attributable to
biliary tract disease. Choledocholithiasis
accounts for approximately 7 percent of
patients with jaundice in pregnancy. 17 Of
patients presenting with pancreatitis
during pregnancy, 90 percent have
choledocholithiasis. 17 Gallstone
pancreatitis is associated with a 15
percent maternal mortality rate and a 60
percent fetal mortality rate. One group of
investigators 17 reported safely
performing endoscopic retrograde
cholangiopancreatography and
endoscopic retrograde sphincterotomy
without complications in five pregnant