Arora Anil, Kumar Ashish, Anand Anil C, Puri Pankaj, Dhiman Radha K, Acharya Subrat K, Aggarwal Kiran, Aggarwal Neelam, Aggarwal Rakesh, Chawla Yogesh K, Dixit Vinod K, Duseja Ajay, Eapen Chundamannil E, Goswami Bhabadev, Gujral Kanwal, Gupta Anoop, Jindal Ankur, Kar Premashish, Kumari Krishna, Madan Kaushal, Malhotra Jaideep, Malhotra Narendra, Pandey Gaurav, Pandey Uma, Puri Ratna D, Rai Ramesh R, Rao Padaki N, Sarin Shiv K, Sharma Aparna, Sharma Praveen, Shenoy Koticherry T, Singh Karam R, Singh Shivaram P, Suri Vanita, Trehanpati Nirupama, Wadhawan Manav
Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Kalinga Institute of Medical Sciences, KIIT University, Bubaneswar, India.
J Clin Exp Hepatol. 2019 May-Jun;9(3):383-406. doi: 10.1016/j.jceh.2019.02.007. Epub 2019 Mar 6.
Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to pregnancy, those coincidental with pregnancy, and preexisting liver diseases exacerbated by pregnancy. A rapid differential diagnosis between liver diseases related or unrelated to pregnancy is required so that specialist and urgent management of these conditions can be carried out. Specific Indian guidelines for the management of these patients are lacking. The Indian National Association for the Study of the Liver (INASL) in association with the Federation of Obstetric and Gynaecological Societies of India (FOGSI) had set up a taskforce for development of consensus guidelines for management of patients with liver diseases during pregnancy, relevant to India. For development of these guidelines, a two-day roundtable meeting was held on 26-27 May 2018 in New Delhi, to discuss, debate, and finalize the consensus statements. Only those statements that were unanimously approved by most members of the taskforce were accepted. The primary objective of this review is to present the consensus statements approved jointly by the INASL and FOGSI for diagnosing and managing pregnant women with liver diseases. This article provides an overview of liver diseases occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and the recommended treatment options.
妊娠期发生的肝脏疾病可能很严重,且进展迅速,会影响母亲和胎儿的结局。它们是产科医生关注的常见原因,也是转诊至肝病专家、胃肠病专家或内科医生的重要原因。妊娠期肝脏疾病可分为妊娠期特有的疾病、与妊娠巧合的疾病以及因妊娠而加重的原有肝脏疾病。需要对与妊娠相关或无关的肝脏疾病进行快速鉴别诊断,以便对这些情况进行专科和紧急处理。目前缺乏针对这些患者的具体印度指南。印度国家肝脏研究协会(INASL)与印度妇产科协会联合会(FOGSI)联合成立了一个特别工作组,以制定与印度相关的妊娠期肝病患者管理共识指南。为制定这些指南,2018年5月26日至27日在新德里举行了为期两天的圆桌会议,以讨论、辩论并最终确定共识声明。只有那些得到特别工作组成员大多数一致认可的声明才被接受。本综述的主要目的是介绍由INASL和FOGSI联合批准的用于诊断和管理患有肝脏疾病的孕妇的共识声明。本文概述了妊娠期发生的肝脏疾病,更新了其发病机制中涉及的关键机制,以及推荐的治疗方案。