Liver Disease Is Common During Pregnancy

Liver diseases that occur before pregnancy or during pregnancy can adversely affect the health of a pregnant woman. The impact of different liver diseases will also have different effects on the mother and fetus.
Changes in the mother's liver during pregnancy
A healthy woman during pregnancy has some liver changes. These are increased cardiac output and blood volume due to increased water and salt retention but normal hepatic blood flow. The amount of blood passing through the liver accounts for 35% of the heart's output of non-pregnant women but only about 28% in pregnant women

. The excess blood will pass through the placenta. Physical examination can detect lipstick and vein palms. Blood tests have few changes in the 3rd trimester, which shows mild cholestasis
6 common liver pathologies in pregnant mothers
Cholestasis in the liver
It is a condition where the bile is trapped in the liver, absorbed into the blood and then absorbed into the skin, causing symptoms of itching and jaundice.



The incidence of this disease is less than 1%. It can vary from mild to severe and usually begins in the 2nd or 3rd trimester.
Itchy skin is most common on palms and feet. Some people may experience itching all over. Symptoms of pruritus progressively increase the number of patients suffering from insomnia and affecting daily activities. Jaundice occurs in 10-20% of people with this disease. The cause of the disease is not well understood, possibly due to genetic factors, increased sensitivity to estrogen The disease is more common in twins or multiple pregnancies due to hormonal increase.




Cholestasis in the liver causing itchy skin
About 50% of patients with cholestatic pregnancy have a family history. Prognosis for good mother. Symptoms disappear about 2 days after birth. However, about 60-70% of patients will get it again next pregnancy and the risk of itchy skin when using birth control pills. But this disease can affect the fetus.
About 60% of mothers with this condition are at risk of preterm birth before 37 weeks. Premature babies have an overall health risk throughout the newborn period and beyond. Some babies die at birth.



This disease also increases the risk of stillbirth with a small percentage (1-2%), fetal failure. Therefore, the fetus should be carefully monitored with ultrasound and fetal heart measurement. If abnormalities may require early delivery to reduce the risk of stillbirth.
A 36-week amniocentesis can be performed to see if the fetal lungs are fully developed; If the normal fetal lungs can breathe on their own, the pregnancy may be ended at 36 to 38 weeks to prevent stillbirth. Vitamin K should be used because of the increased risk of postpartum hemorrhage. Cholestyramine and ursodeoxycholic acid reduce the symptoms of skin itching and correct some liver dysfunctions.
Steatosis
Superior fatty liver in pregnancy is a rare disease that occurs in the last 3 months of pregnancy. The cause is not well understood, possibly due to the genetic factor lacking the enzymes needed for fat metabolism of mitochondrial components in liver cells.




Therefore, fat is deposited with an abnormally large amount inside the liver cells leading to inflammation and degeneration of the liver. When a large number of liver cells become massively necrotic, this will lead to impaired liver function. Symptoms usually begin to occur in the 3rd trimester and are similar to the symptoms of HELLP syndrome.
Steatosis
Epigastric pain or lower right flank, nausea or vomiting, fatigue, headache, jaundice. If not treated promptly, patients may become comatose, renal failure, coagulopathy and death. Due to the natural recovery after birth, the fetus needs to be born as early as possible to avoid serious complications.
Postpartum care includes monitoring blood clotting, blood sugar, kidney failure, and liver dysfunction. Mothers who carry a gene associated with a lack of fat oxidation are at risk of developing fatty liver in other pregnancies.




Hemolytic syndrome, thrombocytopenia and elevated liver enzymes (HELLP)
HELLP stands for hemolysis (hemolysis), elevated liver enzymes (low liver enzymes) and low platelet (thrombocytopenia). The syndrome occurs in 10% of pregnant patients with severe pre-eclampsia. In people with severe pre-eclampsia, when platelets decrease <100,000 / mm3, peripheral blood smears and tests should be considered. Symptoms of HELLP syndrome usually occur in the 3rd trimester of pregnancy, although the syndrome may start earlier. Symptoms may also appear during the first 48 hours after birth. Symptoms of the disease include: epigastric or right upper quadrant pain, nausea or vomiting, fatigue, headache. Pregnant women will experience nausea due to HELLP syndrome HELLP syndrome increases the risk of placental abruption before birth, life-threatening mother and fetus as well as an increased risk of preterm birth. Treat the disease by controlling blood pressure, platelet transfusions if platelets <20,000mm3 or 40,000mm3 accompanied by hemostatic disorders.


Terminate pregnancy immediately to prevent serious complications. If the pregnancy is less than 34 weeks, it is possible to delay about 48 hours to treat the mother with corticoides.
This medication helps accelerate the maturation process of the fetus's lungs and prevents complications of preterm birth. Some suggest high doses of corticoides to improve maternal symptoms. After.

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