RESUMO
BACKGROUND: Urgent delivery of the fetus is often considered as the treatment of choice for mothers in their second or third trimester with hepatitis unique to pregnancy (HUP). OBJECTIVE: To determine whether standard liver function tests (serum bilirubin and international normalized ratio levels) help to identify mothers and their newborns who might benefit from early delivery. METHODS: A total of 149 patients with HUP were retrospectively classified as those with normal (stable-HUP, n=118) or abnormal (progressive-HUP, n=31) liver function tests. Clinical outcomes consisted of maternal lengths of hospital stay after delivery and neonatal appearance, pulse, grimace, activity, respiration score ratings at 0 and 5 min. RESULTS: Patients with stable-HUP had similar lengths of hospital stay after delivery whether delivered early (4.8±3.4 days) or at term (4.8±3.6 days). Appearance, pulse, grimace, activity, respiration score ratings at birth were similar in neonates from patients with stable-HUP delivered prematurely (5.8±2.7) and at term (7.8±1.7, P=0.48) but significantly higher at 5 min in those delivered at term (7.5±2.0 vs. 8.9±0.3, P=0.003). Too few patients with progressive-HUP were delivered at term (N=4) to allow similar comparisons in this cohort. CONCLUSION: The results of this study indicate that mothers with HUP and normal liver function tests (bilirubin and international normalized ratio) can be safely followed to term without jeopardizing the health of either mother or neonates. Additional studies are required to determine whether abnormal liver function tests represent an indication for immediate delivery of the fetus in mothers with HUP.
Assuntos
Parto Obstétrico , Hepatite/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Adulto , Bilirrubina/sangue , Tomada de Decisões , Progressão da Doença , Feminino , Humanos , Recém-Nascido , Coeficiente Internacional Normatizado , Tempo de Internação , Testes de Função Hepática , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
Liver injury and dysfunction in a pregnant woman may be caused by intrinsic features of the pregnancy itself, disorders that are coincidental with pregnancy or pre-existing liver disease that is exacerbated by pregnancy. The clinical setting, gestational age and standard liver biochemistry testing are useful tools in helping to establish a diagnosis. Prompt recognition of the signs of liver disease in pregnant patients leads to timely management and may save the life of both mother and baby. This review summarises the incidence, risk factors, pathogenesis, clinical presentation, diagnosis, treatment and outcome of those liver diseases unique to pregnancy.
