Book of Medical Disorders in Pregnancy - Tintash

Chronic liver disease:
An increased risk of fetal loss has been
noted in pregnant patients with chronic
liver disease. 37 Therapy with penicillamine
(Cuprimine), trientine (Syprine),
prednisone or azathioprine (Imuran) can
be safely continued during pregnancy in
patients with Wilson's disease or autoimmune
hepatitis. 37 In patients with primary
biliary cirrhosis, ursodeoxycholic
acid therapy can be safely continued. 37 In
patients with chronic hepatitis B or C infection,
interferon therapy should be
discontinued during pregnancy, as its
effects on the fetus are unknown. 37
A marked reduction in fertility has been
noted in cirrhotic patients. 37 Cholestasis
may worsen during pregnancy in patients
with primary biliary cirrhosis. Infants
of patients with marked hyperbilirubinemia
during pregnancy may
require exchange transfusion at birth.
Quick review:
Management options:
Acute fatty liver of pregnancy:
Pre pregnancy:
None, except discussion of recurrence
risks (see ‘Postnatal’).
Prenatal: Establish diagnosis,
resuscitate, Intensive care, Supportive
therapy (see labor/delivery) and Plan
delivery.
Labor/delivery:
Maternal resuscitation by correction of
hypoglycemia, fluid imbalance,
coagulopathy and treatment of liver
failure and intensive fetal monitoring.
Urgent delivery when maternal condition
121
is stabilized, vaginal delivery preferable
for mother. Meticulous homeostasis,
including adequate wound drainage.
Postnatal:
Continue intensive care management
watch for postpartum wound hematoma
formation, sepsis, postpartum
hemorrhage, recurrence risk is difficult
to estimate, perhaps as high as 10-20%
Support contraceptive measures.
Management options:
Intrahepatic cholestasis of pregnancy:
Pre pregnancy:
Not applicable, uinless diagnosed in
previous pregnancy, counsel for 60-80%
chance of recurrence, biliary
ultrasonography to detect stones, or
other disease.
Prenatal:
Local antipruritic measures, consider
cholestyramine, ursodeoxycholic acid,
Steroids, Vitamin K supplement, for
mother, Monitor fetal wellbeing,
consider elective delivery and Biliary
tract ultrasonography
Labor/delivery:
Anticipate preterm labour, Increased risk
of postpartum hemorrhage.
Postnatal:
Monitor biochemical resolution, Vitamin
K supplement for baby, Use oral
contraceptives only with close clinical
and biochemical monitoring, Consider
liver biopsy if diagnosis is suspect, for
condition progressive