扬州大学：《妇产科学》课程教学课件（PPT讲稿）14 妊娠合并病毒性肝炎 Hepatitis complicating pregnancy

Viral HepatitisComplicatingPregnancy

Viral Hepatitis Complicating Pregnancy

General ConsiderationHepatitisvirusHAV,HBV,HCV,HDV,HEVHBV:commonIncidence of HV complicating pregnancy6 times than non-pregnancyIncline to develop severe HV

General Consideration • Hepatitis virus HAV, HBV, HCV, HDV, HEV • HBV: common • Incidence of HV complicating pregnancy 6 times than non-pregnancy Incline to develop severe HV

Pregnancy-related changes of hepatic functionAlbumin:20%decreaseAKP: twice normalCholesterol胆固醇：twicenormalSerumtransaminases转氨酶：no changeClotting factorsFibrinogen纤维蛋白原：20%elevationatterm2Factor V,VIl, VIll, IX,Xll: increase3.Factor Xl, Xlll: decreaseAntithrombotic factors: no changePT: no change

Pregnancy-related changes of hepatic function • Albumin: 20% decrease • AKP: twice normal • Cholesterol胆固醇: twice normal • Serum transaminases转氨酶: no change • Clotting factors 1. Fibrinogen纤维蛋白原: 20% elevation at term 2. Factor V,VII, VIII, IX,XII: increase 3. Factor XI, XIII: decrease • Antithrombotic factors: no change • PT: no change

Effects on mother andfetusEffectsonmotherPreeclampsia2.Postpartum hemorrhage3.DICEffectsronfetusMalformation(early pregnancy)2.Abortion,Prematurelabor, fetal deathstillbirth

Effects on mother and fetus • Effects on mother 1. Preeclampsia 2. Postpartum hemorrhage 3. DIC • Effects on fetus 1. Malformation↑(early pregnancy) 2. Abortion, Premature labor, fetal death, stillbirth

Effects on mother andfetus3.Verticaltransmission垂直传播HAV: seldom2)HBVtransplacental transmit, intrapartum transmitpostpartum transmitHCV:2/3HDV: seldomHEV:uncertain

Effects on mother and fetus 3. Vertical transmission垂直传播 1) HAV: seldom 2) HBV transplacental transmit, intrapartum transmit, postpartum transmit 3) HCV: 2/3 4) HDV: seldom 5) HEV: uncertain

DiagnosisHistory: contact,blood transfusionManifestationNausea, vomiting, fatigue, jaundice, liver painLabexaminationALT↑,bilirubinSerologic testing or viral pathogen testingHAV: RNA, HAV-IgM (1st week)2.HBV:HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, dsDNA3.HCV: anti-HCV

Diagnosis • History: contact, blood transfusion • Manifestation Nausea, vomiting, fatigue, jaundice, liver pain • Lab examination ALT↑, bilirubin↑ • Serologic testing or viral pathogen testing 1. HAV: RNA, HAV-IgM (1st week) 2. HBV: HBsAg, anti-HBs, HBeAg, anti-HBe, anti￾HBc, dsDNA 3. HCV: anti-HCV

Diagnosis of acute severe hepatitis（严重食欲减退）Severe anorexia)andvomitingascites (腹水)Progression of jaundice(黄疽)Lessen of liverDysfunction of coagulationcentral neural symptomsAcute renal failure

Diagnosis of acute severe hepatitis • Severe anorexia (严重食欲减退) and vomiting, ascites (腹水) • Progression of jaundice (黄疸) • Lessen of liver • Dysfunction of coagulation • central neural symptoms • Acute renal failure

DifferentialDiagnosisHyperemesisgravidarum（妊娠剧吐）PreeclampsiaAcutefatty liver of pregnancy (AFLP): severehypoglycemiaLiverdysfunction caused bydrug

Differential Diagnosis • Hyperemesis gravidarum (妊娠剧吐) • Preeclampsia • Acute fatty liver of pregnancy (AFLP): severe hypoglycemia • Liver dysfunction caused by drug

TreatmentMild hepatitis: rest and diet (protein andvitamin) and traditional drugSevere hepatitisProtecting liver2.Treatment of coma (香迷)3.Treatment of DIC4Treatment of renal failure5.Obstetric treatmentCS; Preventing postpartum hemorrhage andinfection6.Lactation: HBeAg

Treatment • Mild hepatitis: rest and diet (protein↑and vitamin↑) and traditional drug • Severe hepatitis 1. Protecting liver 2. Treatment of coma (昏迷) 3. Treatment of DIC 4. Treatment of renal failure 5. Obstetric treatment CS; Preventing postpartum hemorrhage and infection 6. Lactation: HBeAg

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