Prevention and treatment of severe hepatitis in pregnancy

doi:10.3877/cma.j.issn.2095-3259.2017.02.007

Abstract

Abstract:

Severe hepatitis refers that lots of liver cells occur necrosis or serious degeneration in a short term, which cause liver failure. The characteristics of severe hepatitis are rapid aggressive clinical course, severe condition, many complications and high fatality. To reduce maternal and perinatal mortality, the treatments of sever hepatitis not only emphasize on early recognition, timely referral, close monitoring, antiviral treatment and interdisciplinary cooperation, but also include prevention the complications actively and terminating pregnancy timely.

Key words: Pregnancy, high-risk, Hepatitis, Hepatic encephalopathy, Hepatorenal syndrome, Antiviral agents

Guorong Han, Chuanlu Xu. Prevention and treatment of severe hepatitis in pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(02): 92-97.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhckjjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3259.2017.02.007

https://zhckjjdzzz.cma-cmc.com.cn/EN/Y2017/V06/I02/92

Figures/Tables 1

References 35

[1]	Lefkowitch JH. The pathology of acute liver failure[J]. Adv Anat Pathol, 2016, 23(3):144-158.
[2]	Li XM, Ma L, Yang YB, et al. Clinical characteristics of fulminant hepatitis in pregnancy[J]. World J Gastroenterol, 2005, 11(29):4600-4603.
[3]	Jin H, Zhao Y, Zhang X, et al. Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis[J]. Epidemiol Infect, 2016, 144(10):2098-2106.
[4]	Khuroo MS, Khuroo MS, Khuroo NS. Discovery, global impact, control and cure[J]. World J Gastroenterol, 2016, 22(31):7030-7045.
[5]	Licata A, Ingrassia D, Serruto A, et al. Clinical course and management of acute and chronic viral hepatitis during pregnancy[J]. J Viral Hepat, 2015, 22(6):515-523.
[6]	Halliday J, Lokan J, Angus PW, et al. A case of fulminant hepatic failure in pregnancy[J]. Hepatology, 2010, 51(1):341-342.
[7]	李小毛. 妊娠合并重型肝炎的治疗现状及进展[J]. 新医学，2005, 36(2):65-67.
[8]	马洁，刘建. 妊娠合并重症肝炎的诊治进展[J]. 医学信息，2014, 27(4):495-496.
[9]	郝秀兰，侯红瑛. 关于妊娠合并重症肝炎[J/CD]. 中华产科急救电子杂志，2012, 1(1):14-16.
[10]	尹玉竹，周瑾. 妊娠合并肝衰竭的产科处理[J/CD]. 中华产科急救电子杂志，2014, 3(3):172-175.
[11]	黄琳琳，刘建. 妊娠合并重症肝炎治疗进展[J]. 中外医疗，2015, (11):194-196.
[12]	McCormick PA, Donnelly C. Management of hepatorenal syndrome[J]. Pharmacol Ther, 2008, 119(1):1-6.
[13]	Li M, Sun J, Li J, et al. Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver[J]. Exp Ther Med, 2016, 12(6):3873-3876.
[14]	Komura T, Taniguchi T, Sakai Y, et al. Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure[J]. J Gastroenterol Hepatol, 2014, 29(4):782-786.
[15]	Wu DB, Chen EQ, Bai L, et al. Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature[J]. Ther Clin Risk Manag, 2017, 13:65-68.
[16]	Mendizabal M, Rowe C, Piñero F, et al. Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy[J]. Ann Hepatol, 2014, 13(2):288-292.
[17]	唐晖，傅斌生，易慧敏，等. 肝移植治疗妊娠期合并急性肝衰竭2例并文献复习[J]. 器官移植，2015, 6(6):388-391.
[18]	Mendizabal M, Silva MO. Liver transplantation in acute liver failure: A challenging scenario[J]. World J Gastroenterol, 2016, 22(4):1523-1531.
[19]	Fukumitsu K, Yagi H, Soto-Gutierrez A．Bioengineering in organ transplantation: targeting the liver[J]. Transplant Proc, 2011,43(6):2137-2138.
[20]	Pan CQ, Lee HM. Antiviral therapy for chronic hepatitis B in pregnancy[J]. Semin Liver Dis, 2013, 33(2):138-146.
[21]	Pan CQ, Han GR, Jiang HX, et al. Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2012, 10(5):520-526.
[22]	Han GR, Jiang HX, Wang CM, et al. Long-term safety and efficacy of telbivudine in infants born to mothers treated during the second or third trimesters of pregnancy[J]. J Viral Hepat, 2017, 24(2):514-521.
[23]	Han GR, Cao MK, Zhao W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55(6):1215-1221.
[24]	Han GR, Jiang HX, Yue X, et al. Efficacy and safety of telbivudine treatment: an open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Viral Hepat, 2015, 22(9):754-762.
[25]	Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study[J]. J Viral Hepat, 2009, 16(2):94-103.
[26]	Tran TT. Management of hepatitis B in pregnancy: weighing the options[J]. Cleve Clin J Med, 2009, 76(Suppl 3):S25-S29.
[27]	Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis b transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374(24):2324-2334.
[28]	Chang ML, Liaw YF. Hepatitis B flares in chronic hepatitis B: pathogenesis, natural course, and management[J]. J Hepatol, 2014, 61(6):1407-1417.
[29]	Han GR, Xu CL, Zhao W, et al. Management of chronic hepatitis B in pregnancy[J]. World J Gastroenterol, 2012, 18(33):4517-4521.
[30]	韩国荣，丁祎. 慢性乙型肝炎育龄妇女及孕妇的抗病毒治疗指征与时机的选择[J]. 中华肝脏病杂志，2015, 23(11):806-809.
[31]	Chen H, Yuan L, Tan J, et al. Severe liver disease in pregnancy[J]. Int J Gynaecol Obstet, 2008, 101(3):277-280.
[32]	李小毛. 晚期妊娠合并重型肝炎产科处理的若干问题[J]．广东医学，2007, 28(5):683-684.
[33]	Deng L, Li X, Shi Z, et al. Maternal and perinatal outcome in cases of fulminant viral hepatitis in late pregnancy[J]. Int J Gynaecol Obstet, 2012, 119(2):145-148.
[34]	Labrique AB, Sikder SS, Krain LJ, et al. Hepatitis E, a vaccine preventable cause of maternal deaths[J]. Emerg Infect Dis, 2012, 18(9):1401-1404.
[35]	Kumar M, Singh T, Sinha S. Chronic hepatitis B virus infection and pregnancy[J]. J Clin Exp Hepatol, 2012, 2(4):366-381.

疾病	既往病史	发病孕周	临床表现与体征	实验室检查结果
妊娠合并重症肝炎	病毒性肝炎	任何孕周，孕中晚期多见	消化道症状、黄疸、肝臭、肝性脑病	肝炎病毒标志物阳性，胆红素升高、胆酶分离、血氨升高
妊娠期急性脂肪肝	无	妊娠晚期	消化道症状、黄疸、肝性脑病	肝炎病毒标志物阴性、ALT<500 U/L，高胆红素血症、DIC、血小板减少、严重凝血功能障碍、低血糖、血氨升高、白细胞升高
重度子痫前期	妊娠期高血压	20周以后	头痛、头晕、视力模糊、严重者神志不清、昏迷、血压升高	肝炎病毒标志物阴性、血氨正常、蛋白尿
妊娠期糖尿病酮症酸中毒	妊娠期糖尿病	任何孕周	轻度口渴、多饮多尿、消化道症状、嗜睡、意识模糊、昏迷	肝炎病毒标志物阴性、血氨正常、血糖升高、酮体阳性

疾病	既往病史	发病孕周	临床表现与体征	实验室检查结果
妊娠合并重症肝炎	病毒性肝炎	任何孕周，孕中晚期多见	消化道症状、黄疸、肝臭、肝性脑病	肝炎病毒标志物阳性，胆红素升高、胆酶分离、血氨升高
妊娠期急性脂肪肝	无	妊娠晚期	消化道症状、黄疸、肝性脑病	肝炎病毒标志物阴性、ALT<500 U/L，高胆红素血症、DIC、血小板减少、严重凝血功能障碍、低血糖、血氨升高、白细胞升高
重度子痫前期	妊娠期高血压	20周以后	头痛、头晕、视力模糊、严重者神志不清、昏迷、血压升高	肝炎病毒标志物阴性、血氨正常、蛋白尿
妊娠期糖尿病酮症酸中毒	妊娠期糖尿病	任何孕周	轻度口渴、多饮多尿、消化道症状、嗜睡、意识模糊、昏迷	肝炎病毒标志物阴性、血氨正常、血糖升高、酮体阳性

Please choose a citation manager

Content to export