Lata Indu
Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Int J Crit Illn Inj Sci. 2013 Jul;3(3):175-82. doi: 10.4103/2229-5151.119196.
Liver diseases in pregnancy although rare but they can seriously affect mother and fetus. Signs and symptoms are often not specific and consist of jaundice, nausea, vomiting, and abdominal pain. Although any type of liver disease can develop during pregnancy or pregnancy may occur in a patient already having chronic liver disease. All liver diseases with pregnancy can lead to increased maternal and fetal morbidity and mortality. It is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiological changes of normal pregnancy can be confounding with that of sign and symptoms of liver diseases. Telangiectasia or spider angiomas, palmar erythema, increased alkaline phosphatase due to placental secretion, hypoalbuminemia due to hemodilution. These normal alterations mimic physiological changes in patients with decompensated chronic liver disease. Besides all these pathological changes however, blood flow to the liver remains constant and the liver usually remains impalpable during pregnancy. The diagnosis of liver disease in pregnancy is challenging and relies on laboratory investigations. The underlying disorder can have a significant effect on morbidity and mortality in both mother and fetus, and a diagnostic workup should be initiated promptly. If we see the spectrum of liver disease in pregnancy, in mild form there occur increase in liver enzymes to severe form, where liver failure affecting the entire system or maternal mortality and morbidity. It can not only complicate mother's life but also poses burden of life of fetus to growth restriction. Most of the times termination is only answer to save life of mother but sometimes early detection of diseases, preventive measures and available active treatment is helpful for both of the life. Extreme vigilance in recognizing physical and laboratory abnormalities in pregnancy is a prerequisite for an accurate diagnosis. This could lead to a timely intervention and successful outcome.
妊娠期肝病虽然少见，但可严重影响母亲和胎儿。其体征和症状往往不具特异性，包括黄疸、恶心、呕吐和腹痛。虽然孕期可发生任何类型的肝病，或者肝病也可能发生在已有慢性肝病的患者身上。所有妊娠期肝病均可导致孕产妇和胎儿发病率及死亡率增加。由于生理变化，很难识别孕妇肝病的特征。正常妊娠的生理变化可能与肝病的体征和症状相混淆。如毛细血管扩张或蜘蛛状血管瘤、掌部红斑、胎盘分泌导致碱性磷酸酶升高、血液稀释导致低白蛋白血症。这些正常改变类似于失代偿性慢性肝病患者的生理变化。然而，除了所有这些病理变化外，孕期肝脏血流保持恒定，肝脏通常仍无法触及。妊娠期肝病的诊断具有挑战性，依赖于实验室检查。潜在疾病可对母亲和胎儿的发病率和死亡率产生重大影响，应立即启动诊断性检查。如果观察妊娠期肝病的范围，轻度时会出现肝酶升高，严重时则会出现肝功能衰竭影响整个系统或导致孕产妇死亡和发病。它不仅会使母亲的生活复杂化，还会给胎儿的生长发育带来负担，导致生长受限。大多数情况下，终止妊娠是挽救母亲生命的唯一办法，但有时早期发现疾病、采取预防措施和进行有效的治疗对两者的生命都有帮助。在孕期识别身体和实验室异常时保持高度警惕是准确诊断的前提。这可能会带来及时的干预和成功的结果。
