RESUMEN
Liver disease during pregnancy is more common than expected and may require specialized intervention. It is important to determine if changes in liver physiology may develop into liver disease, to assure early diagnosis. For adequate surveillance of mother-fetus health outcome, liver disease during pregnancy might require intervention from a hepatologist. Liver diseases have a prevalence of at least 3% of all pregnancies in developed countries, and they are classified into two main categories: related to pregnancy; and those non- related that are present de novo or are preexisting chronic liver diseases. In this review we describe and discuss the main characteristics of those liver diseases associated with pregnancy and only some frequent pre-existing and co-incidental in pregnancy are considered. In addition to the literature review, we compiled the data of liver disease occurring during pregnancies attended at the National Institute of Perinatology in Mexico City in a three-year period. In our tertiary referral women hospital, liver disease was present in 11.24 % of all pregnancies. Associated liver disease was found in 10.8% of all pregnancies, mainly those related to pre-eclampsia (9.9% of pregnancies). Only 0.56% was due to liver disease that was co-incidental or preexisting; the acute or chronic hepatitis C virus was the most frequent in this group (0.12%). When managing pregnancy in referral hospitals in Latin America, it is important to discard liver alterations early for adequate follow up of the disease and to prevent adverse consequences for the mother and child.
Asunto(s)
Hepatopatías/terapia , Complicaciones del Embarazo/terapia , Síndrome de Budd-Chiari/epidemiología , Síndrome de Budd-Chiari/fisiopatología , Síndrome de Budd-Chiari/terapia , Colestasis Intrahepática/epidemiología , Colestasis Intrahepática/fisiopatología , Colestasis Intrahepática/terapia , Hígado Graso/epidemiología , Hígado Graso/fisiopatología , Hígado Graso/terapia , Femenino , Síndrome HELLP/epidemiología , Síndrome HELLP/fisiopatología , Síndrome HELLP/terapia , Hepatitis Viral Humana/epidemiología , Hepatitis Viral Humana/fisiopatología , Hepatitis Viral Humana/terapia , Degeneración Hepatolenticular/epidemiología , Degeneración Hepatolenticular/fisiopatología , Degeneración Hepatolenticular/terapia , Humanos , Hiperemesis Gravídica/epidemiología , Hiperemesis Gravídica/fisiopatología , Hiperemesis Gravídica/terapia , Hipertensión Portal/epidemiología , Hipertensión Portal/fisiopatología , Hipertensión Portal/terapia , Recién Nacido , Cirrosis Hepática/epidemiología , Cirrosis Hepática/fisiopatología , Cirrosis Hepática/terapia , Hepatopatías/epidemiología , Hepatopatías/fisiopatología , Trasplante de Hígado , México/epidemiología , Preeclampsia/epidemiología , Preeclampsia/fisiopatología , Preeclampsia/terapia , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Centros de Atención TerciariaRESUMEN
Nausea and vomiting of pregnancy, "morning sickness", is a common contemporary complaint. Many pregnant patients note alterations in smell and taste which can precipitate "morning sickness", symptoms that characterize early gestation. Epidemiologic studies suggest that pregnancies accompanied by "morning sickness" have better outcomes than asymptomatic pregnancies. The intimate connection between immunogenetic identity, chemoidentity, and chemocommunication by olfactory mechanisms suggests a relationship between maternal symptoms and maternal accommodation of paternal antigens contained in the fetoplacental unit. Most mammalian species utilize olfaction to reduce inbreeding and thus do not require an intimate placental connection between mother and fetus. The evolution of Homo sapiens included prolonged periods of small, genetically homogeneous foraging groups which limited selection of genetically heterogeneous mates. Adaptation to this circumstance included a reduction of olfactory precision in mate selection and a more intimate association between mother and fetus, the hemochorial placenta
Asunto(s)
Humanos , Femenino , Embarazo , Complicaciones del Embarazo , Hiperemesis Gravídica/fisiopatología , Vómitos , Células Quimiorreceptoras , NáuseaRESUMEN
Se analizan las hepatopatías propias del embarazo, según las últimas investigaciones y por la experiencia del Departamento de Anatomía Patológica del Hospital Central de San Luis Potosí. Tales entidades son: el hígado graso, la hiperemesis gravídica, la preeclampsia y eclampsia y la colestesis del embarazo. Se estima que el estado eclámtico es capaz de dar manifestaciones clínicas, de laboratorio o estructurales, absolutamente variables, que llevan a juzgarse como dependientes al hígado graso, al síndrome HELLP y a algunos casos de colestasis. A su vez, la colestasis del embarazo, genéticamente determinada, debe difundirse de la asociada a la eclampsia o determinada por drogas u otras causas. Similarmente, la hiperemesis gravídica puede ser primaria, aunque rara u obedecer a causas neurológicas; es capaz también de producir disfunción hepática ligera. finalmente, se ubican los padecimientos anteriores dentro del esquema clásico fisiopatológico de las ictericias.
Asunto(s)
Humanos , Femenino , Embarazo , Persona de Mediana Edad , Colestasis Intrahepática/fisiopatología , Eclampsia/fisiopatología , Hígado Graso/fisiopatología , Hiperemesis Gravídica/fisiopatología , Preeclampsia/fisiopatología , Complicaciones del Embarazo/diagnóstico , Colestasis Intrahepática/patología , Hígado Graso/patología , Hiperemesis Gravídica/patología , Hepatopatías/etiología , Hepatopatías/fisiopatología , Complicaciones del Embarazo/fisiopatologíaRESUMEN
During pregnancy, biochemical evaluation of the liver is affected in many significan ways. Alkaline phosphatase increases in the third trimester and rapidly returns to the normal limits after delivery. This increase is clearly secondary to the placental isoenzyme. AST and ALT are usually normal and GGTP doens't changes significantly. Hepatic flow remains unchanged and estrogen levels increase leading to several metabolic and cutaneous changes, such as hepatic palms and systemic vasodilatation. Liver diseases that occur during pregnancy can be classified as follows: a) Entities exclusive of pregnancy, b) Pregnancy associated diseases, and c) Previous liver diseases. The first group included: 1. Cholestasis of pregnancy, described mainly in Scandinavian and Chilean women and characterized by pruritus in the third trimester, biochemical evidence of cholestasis, increased frequency of cholelitiasis and fetal problems. The entity usually recurs in other pregnancies or during exposure to estrogens. Prognosis is good and the patient improves rapidly after delivery. Several reports have shown that s-Adenosyl-Methionine can be effective. 2) Hyperemesis gravidarum, characterized by protacted vomiting associated to significant malnutrition. Liver function tests are usually abnormal and the liver biopsy shows no specific changes. Prognosis is usually good and most of the patients improved spontaneously. 3) Acute fatty liver, is one of the causes of liver failure during the third trimester and is associated with a very high maternal mortality. Clinically the patient presents with encephalopathy, biochemical evidence of liver failure and microvesicular fat in the liver...