The hepatic pathology in obstetrics

Abstract

The main causes of hepatic pathology related to pregnancy are pre-eclampsia, HELLP syndrome, acute fatty hepatosis of pregnant women, and cholestatic hepatosis of pregnant woman. This pathology needs a multidisciplinary approach. The medical care to female patients with hepatic dysfunction/pathology is to be provided in multitype hospitals of high-top level. It is ultimately important that not only obstetrician-gynecologist are aware about the characteristics of this pathology but also anesthetist, resuscitation specialist, surgeon, therapist, gastroenterologist, infectiologist, transfusiologist and physician of department of hemodialysis. This level of awareness will promote early diagnostic and timely emergency care support. All variants of hepatic pathology related to pregnancy have both genetic determination and many common in etiology and pathogenesis. They are extremely difficult for early detection and differentiate diagnosis. The results of pathomorphology analysis testify the severity of affection of liver from causes related to pregnancy and make it possible to exactly differentiate them intravital biopsy included. In the case of manifestation of obvious clinical picture of hepatic pathology and its complications the only etio-pathogenic method of treatment remains timely delivery though in certain cases no amelioration of condition occurs. As a rule, the choice of method of delivery totally depends on obstetric situation. The advantages of operative or conservative method are not determined yet. The effectiveness of methods of pharmaceutical therapy and methods of detoxification (plasmapheresis, MAPS) has no proof nowadays. The transplantation of liver under HELLP-syndrome and acute fatty hepatosis of pregnant women factually has no development in Russia. Just that is why it is so important to detect and to take into account the slightest clinical and laboratory manifestations of hepatic dysfunction during pregnancy. No less important it is to determine the tactics of treatment and delivery as well.

Keywords

hepatic pathology / pre-eclampsia / HELLP-syndrome / acute fatty hepatosis of pregnant women / intra-hepatic cholestasis of pregnant women / intensive therapy

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