Acute fatty liver of pregnancy:

• -AFLP is a rare condition

• -unknown etiology

• -(although fetal long-chain hydroxyacyl co-enzyme A dehydrogenase (LCHAD) deficiency).

• - It has an incidence in various studies of between 1 in 7000 and 1 in 13 000 pregnancies.

• - It is frequently fatal for the mother and baby unless there is a speedy diagnosis and the correct treatment is given.

• Clinical manifestation :• - an obese woman will present with

vomiting and a headache in her third trimester.

• - She will quickly complain of malaise and severe abdominal pain, followed by jaundice and drowsiness.

• -50% of these women have symptoms of pre-eclampsia (hypertension and proteinuria),

• -the pre-eclampsia will mask the presentation of AFLP.• liver is tender but not enlarged• diagnosis:• -an ultrasound• -computerized tomography (CT) scan of the liver

demonstrates fatty infiltration. -Liver biopsy is contraindicated owing to the risk of coagulopathy.

• -The liver enzymes are moderately raised and the woman will also quickly show -renal failure (liver function test )

• -blood glucose level (hypoglycemic.)

• Management :• -correcting any coagulopathy : infusing fresh

frozen plasma.• - The woman must be delivered immediately.• -Caesarean section is said to have many

advantages for the baby, but it is safest for the mother to birth vaginally if this is possible.

• - Epidural analgesia is contraindicated in all .• -Convalescence is prolonged but usually

complete.• -recurrence rate is low.

•Gall bladder disease• -Pregnancy appears to increase the likelihood of

gallstone formation but not the risk of developing acute cholecystitis.

• Diagnosis of gall bladder disease is made by :• 1-listening to the woman's previous history• 2- an ultrasound scan of the hepatobiliary tract

or both.

-treatment of the biliary colic by:

• * analgesia, hydration, nasogastric suction(compression ) and antibiotics.

• Surgery should be avoided if at all possible.

•Viral hepatitis:

• Viral hepatitis is the most common cause of jaundice in pregnancy.

• - Acute infection 1 in 1000 pregnancies

• - an incubation period of 1–6 months.

• Symptoms include :• -nausea• - Vomiting• - anorexia• - pain over the liver• - mild diarrhea • -jaundice lasting several weeks• -malaise.• - Fever is rare.• - the disease is asymptomatic, or mimics mild

influenza

• Method of transmission :

• -blood, blood products.

• - sexual activity.

• - The virus can also be transmitted across the placenta.

•-Hepatitis B :

• -is more common in tropical and developing countries.

• -poor nutrition.• - limited use of contraception barrier)• -injecting drug users who share needles • -The more common infections are known as

hepatitis A, B ,C ,D and E

• **Hepatitis A (HAV):• -acute infection • -transmitted by ingesting water contaminated .• - It is endemic worldwide.• - Mother to baby transmission is rare but can occur

at birth.• - HAV is a self-limiting illness results in complete

recovery. • -Vaccination is available.• - Strict hygiene• -hand washing ,reduces the risk of cross infection

• Hepatitis B (HBV) :

• -serious infection.

• - 5–10% of those infected become chronic carriers.

• - 25–30% of these will die.

• - 0.5–5% of the population are chronic HBV carriers.

• - test for the HBV surface antigen (HBsAg).

• - adults 90% cases of HBV resolve completely within 1–3 months.

• -complications of HBV:

• transplacental passage of the virus and through blood and body fluids at birth.

• 1-increased risk of chronic liver disease.

• 2-cirrhosis

• 3-primary liver cancer in later life.

• -Caesarean section does not prevent mother to fetus transmission.

• Diagnosis :

• history of her symptoms and lifestyle.

• Serological studies, but it can be difficult to distinguish hepatitis B from other forms of viral hepatitis during the acute presentation, before antibodies have formed

• Treatment :

• Symptoms

• Infection control measures ,the woman is considered to be infectious.

• Education about the disease, nutrition and sexual advice, should be offered. -Liver function will be monitored

• Assess fetal condition. • Household contacts should be offered

immunization after their HBsAg was done . • -Sexual partners should testing and giving

vaccination.• Postnatally the mother will be encouraged to

accept vaccination for the baby. Breastfeeding is permitted

Hepatitis C virus (HCV): risk factors for transmission

are blood and blood products.the use of shared intravenous needles.

post-blood transfusion hepatitis

• HCV commonly from a blood donorHCV commonly from a blood donor

• who had yet to sero-convert at the who had yet to sero-convert at the time of blood donationtime of blood donation

• incubation period of 30–60 daysincubation period of 30–60 days

• 75% asymptomatic. In the remaining .75% asymptomatic. In the remaining .

• 25% symptoms include transient 25% symptoms include transient nausea and jaundicenausea and jaundice

• Complications ;

• chronic HCV which is associated with B cell lymphomas .

• chronic liver disease.

• (vertical) transmission from pregnant women and placental the baby.

• Type of birth normal .

• breastfeeding safe.

• No vaccine is available yet

Pregnancy and liver transplantation:

– -liver transplantation done before or during pregnancy, many with successful outcomes.

– -Although not desirable.– - liver transplantation in women of childbearing

age is becoming possible -women require expert medical and midwifery care at a specialized centre

Ready to deal with all of the complications, both of a physical and psychological nature

Thank you