Acute viral hepatitis in pregnancy.

OBJECTIVE: To describe the clinical outcome of pregnancy and vertical transmission of acute viral hepatitis in pregnancy. METHODS: Forty-eight pregnant patients with acute viral hepatitis were evaluated clinically and by abdominal ultrasonography. Serological studies for hepatitis markers were performed using radioimmunoassay. The results were evaluated using Student's t-test and tests of proportion. RESULT: Thirty-five (72.9%) delivered live birth babies at term, while 13 (27.1%) had fetal complications and/or losses. The percentage of fetal complications and/or losses was higher in patients who had non-A, non-B hepatitis (30.8%) than those who had type B hepatitis (25%). The most common fetal complication was premature delivery (14.9%) followed by stillbirth and abortion (8.3%) for each. The overall percentage of vertical transmission of hepatitis B virus was 2 out of 27 (7.4%). CONCLUSION: Acute viral hepatitis carries a high risk for both mother and fetus. Routine vaccination of all susceptible women and babies against hepatitis B is recommended in endemic areas.

Effect of subdermal levonorgestrel contraceptive implants, Norplant, on liver functions.

Forty-seven normal health women were studied longitudinally for changes in liver functions during the use of the levonorgestrel contraceptive implant system, NORPLANT. Samples were collected before insertion of the implants and after one, three and six months of use. The enzymes studied were the transaminases (SGOT and SGPT), alkaline phosphatase and gamma-glutamyl transferase. Serum bilirubin and bile acid levels were also measured. The protein synthetic function of the liver was tested by estimation of total proteins, albumin, transferrin, hemopexin, ceruloplasmin and haptoglobin. The three main immunoglobulins, G, M and A, were also measured. There were no significant changes in the liver enzymes after NORPLANT use. Serum bilirubin and bile acid concentrations showed rises in the first month of use which ameliorated in subsequent months. Serum albumin was transiently increased during the first and third months. Ceruloplasmin decreased significantly at the sixth month. The concentrations of total serum proteins and the other individual proteins showed no significant change. The results point to safety of NORPLANT implant use, as regards hepatic functions.

Effects of oral contraception on liver function tests and serum proteins in women with past viral hepatitis.

Forty-three women who had viral hepatitis one or more years ago and 35 healthy women who were age and parity matched were given an oral contraceptive containing 0.05mg ethinyl estradiol and 0.5mg levonorgestrel for six consecutive months. Liver function tests (serum bilirubin, SGOT, SGPT and serum alkaline phosphatase) and serum proteins (total, albumin, globulins, ceruloplasmin, haptoglobin and alpha-1 antitrypsin) were measured before beginning treatment and after three and six months of use. Past hepatitis women experienced increased unconjugated bilirubin, SGOT, SGPT and alkaline phosphatase levels throughout the six months while the control women showed less pronounced changes during the first three months with tendency to reversion to normal during the subsequent three months; the group X time of test interactions were significantly different between the two groups. Serum haptoglobin decreased significantly in both groups but the past-hepatitis group showed a more persistent change with time. Changes also occurred in serum albumin, alpha-1 and beta globulins, ceruloplasmin but without group effect or group X time interactions.

Effects of oral contraception on liver function tests and serum proteins in women with active schistosomiasis.

Thirty-eight women with urinary or intestinal schistosomiasis but without clinical or laboratory evidence of hepatic involvement and 30 healthy control women were treated with an oral contraceptive containing 0.05mg ethinyl estradiol and 0.05mg levonorgestrel for six consecutive months. Liver function tests (serum bilirubin, SGOT, SGPT, serum alkaline phosphatase) and serum proteins (total, albumin, globulins, ceruloplasmin, haptoglobin and alpha-1 antitrypsin) were measured before beginning the treatment and after three and six months of use. Both group experienced significant increases in SGOT, SGPT and serum alkaline phosphatase during the first three months of treatment with tendencies to decrease during the subsequent 3 months. No change occurred in serum bilirubin. There was significant decreases in serum albumin and haptoglobin and increases in alpha-1 globulin, ceruloplasmin and alpha-1 globulin, there were no significant differences between schistosomiasis patients and the controls in terms of changes in any laboratory test as a result of the treatment, thus suggesting that patients with active schistosomiasis do not incur a higher risk of hepatic dysfunction while using oral contraception.

Sex steroids in women with liver cirrhosis.

Eighteen women with hepatic cirrhosis were examined for plasma levels of testosterone, estrone, estradiol, progesterone and sex hormone binding globulin. For eight who were amenorrheic, with advanced liver cirrhosis and ascites, the reduction of testosterone and rise in estrone and sex hormone binding globulin concentrations were significant. Plasma extradiol and progesterone were lower than normal levels, but the differences were not statistically significant. The other ten patients were menstruating (mostly irregularly), and their hormonal levels were assessed in different states of their cycles. All of them did not ovulate, had low levels of plasma progesterone and also showed consistent estrone concentration excess relative to estradiol and significant lowering of testosterone and elevation of sex hormone binding globulin. These findings are compared with previous reports on males with liver cirrhosis.