Pregnancy Complicated By Chronic Liver Disease
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 9
Abstract
Introduction: Pregnancy is unusual in women with severe chronic liver disease due to hypothalamic pituitary dysfunction which may result in infertility. A favourable outcome for the pregnancy is possible but is dependent on the type well as severity of the un-derlying condition and any associated co-morbidities. Multidisclipinary patient centric approach , along with a compliant patient and family support will enable optimum outcome . Patients And Methods: Ten pregnancies with chronic liver disease over a fifteen year period were followed up antenatally and postnatally in sevice tertiary care hospitals . Nine patients with autoimmune hepatitis were diagosed antenatally and were on medication prior to conception and were under mul-tidisciplinary care.One patient with portal hyperten-sion was diagnosed post partum . Results : We present ten patients of pregnancy with chronic liver disease . Nine patients had auto-immune hepatitis. One patient had portal hyperten-sion . In this study, 6/9 patients(66.6%) were treated with azathioprine (AZA) and 8/9 patients (88.8%) with prednisolone. Antenatally patients remained and one patient had postabortal exacerbation .There were five live births(56%) and three preterm deliveries (33%).There were three first trimester miscarriages (44%). There were no neonatal or maternal deaths . The patient with portal hypertension had an antenatal intrauterine fetal death and had Acute Postpar-tum Decompensation with multiorgan failure and disseminated intravascular coagulation and was man-aged under multidisciplinary care successfully . Conclusion: The spectrum of chronic liver disease in pregnancy may range from a mild to a severe pattern. Women with less severe disease,well con-trolled preconceptually, well compensated liver function , without features of portal hypertension and without any critical co- morbidity can become pregnant and have a generally favourable pregnancy out-comes. In patients who become pregnant , maternal problems in terms of exacerbation of underlying dis-eaease process bleeding from esophageal varices and preterm labour and hepatic decompensation can take place . In the fetus ,miscarriage , fetal growth retardation ,stillbirth or neonatal death can result. The need for disease control before, during pregnancy and in the postpar-tum period, careful materno fetal surveillance during pregnancy, and enhanced medical multidisciplinary involvement is emphasised.
Authors and Affiliations
Dr. Karminder Dhillon
Keywords
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