liver disease in pregnancy - mucosal immunology · general considerations bibleclass 23.09.2015,...
TRANSCRIPT
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Liver Disease in Pregnancy
Bibleclass 23.09.2015
Felix Brunner
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General Considerations
Bibleclass 23.09.2015, Brunner 2
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General Considerations
Bibleclass 23.09.2015, Brunner 2
Intrahepatic
Cholestasis of
Pregnancy
HELLP
Pre-existing Liver
Cirrhosis
Bile Stone
Disease
![Page 4: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/4.jpg)
General Considerations
Bibleclass 23.09.2015, Brunner 2
Intrahepatic
Cholestasis of
Pregnancy
HELLP
Pre-existing Liver
Cirrhosis
Bile Stone
Disease
Acute Fatty Liver
of Pregnancy
![Page 5: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/5.jpg)
General Considerations
Bibleclass 23.09.2015, Brunner 2
Intrahepatic
Cholestasis of
Pregnancy
HELLP
Pre-existing Liver
Cirrhosis
Bile Stone
Disease
Acute Fatty Liver
of Pregnancy
Hepatitis B
![Page 6: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/6.jpg)
Physiological Changes in
Pregnancy
Bibleclass 23.09.2015, Brunner 3
Cardiovascular Endocrinological
Biliary
Lab Parameter
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Physiological Changes in
Pregnancy
Bibleclass 23.09.2015, Brunner 3
Cardiovascular
• Heart Rate,
Cardiac output ⬆• Blood pressure,
vascular
resistance ⬇• 50% blood
volume
Endocrinological
Biliary
Lab Parameter
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Physiological Changes in
Pregnancy
Bibleclass 23.09.2015, Brunner 3
Cardiovascular
• Heart Rate,
Cardiac output ⬆• Blood pressure,
vascular
resistance ⬇• 50% blood
volume
Endocrinological
Biliary
Lab Parameter
• Alk. Phosph⬆• Albumin ⬇
![Page 9: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/9.jpg)
Physiological Changes in
Pregnancy
Bibleclass 23.09.2015, Brunner 3
Cardiovascular
• Heart Rate,
Cardiac output ⬆• Blood pressure,
vascular
resistance ⬇• 50% blood
volume
Endocrinological
• Hyperestrogenic
state
Spider Nävi
Palmar
erythema
Biliary
Lab Parameter
• Alk. Phosph⬆• Albumin ⬇
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Physiological Changes in
Pregnancy
Bibleclass 23.09.2015, Brunner 3
Cardiovascular
• Heart Rate,
Cardiac output ⬆• Blood pressure,
vascular
resistance ⬇• 50% blood
volume
Endocrinological
• Hyperestrogenic
state
Spider Nävi
Palmar
erythema
Biliary
• Gallbladder
Motility ⬇
Lab Parameter
• Alk. Phosph⬆• Albumin ⬇
![Page 11: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/11.jpg)
Overview
• Hyperemesis Gravidarum
• Intrahepatic Cholestasis of
Pregnancy
• Pre-Eclampsia & Eclampsia
• HELLP-Syndrom
• Acute Fatty Liver in Pregnancy
• HBV Transmission
4Bibleclass 29.04.2015, Brunner
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Hyperemesis Gravidarum
Bibleclass 23.09.2015, Brunner 5
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Hyperemesis Gravidarum
Trimester: 1-2
Bibleclass 23.09.2015, Brunner 5
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Hyperemesis Gravidarum
Trimester: 1-2
Symptoms: Intractable Vomitus
Ketosis
Bibleclass 23.09.2015, Brunner 5
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Hyperemesis Gravidarum
Trimester: 1-2
Symptoms: Intractable Vomitus
Ketosis
5% Weight loss
Bibleclass 23.09.2015, Brunner 5
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Hyperemesis Gravidarum
Trimester: 1-2
Symptoms: Intractable Vomitus
Ketosis
5% Weight loss
Epidemiology: 0.3-2% of all Pregnancies
Bibleclass 23.09.2015, Brunner 5
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Hyperemesis Gravidarum
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Diabetes mellitus
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Diabetes mellitus
Multiple Pregnancies
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Diabetes mellitus
Multiple Pregnancies
Positive Family History
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Diabetes mellitus
Multiple Pregnancies
Positive Family History
Bibleclass 23.09.2015, Brunner 6
![Page 25: Liver Disease in Pregnancy - Mucosal Immunology · General Considerations Bibleclass 23.09.2015, Brunner 2 Intrahepatic Cholestasis of Pregnancy HELLP Pre-existing Liver Cirrhosis](https://reader031.vdocument.in/reader031/viewer/2022040701/5d5935da88c9937f388bbb96/html5/thumbnails/25.jpg)
Hyperemesis Gravidarum
Mechanism: Mixed (Motility, Hormonal, ANS)
Risk Factors: ⬆ BMI
Psychiatric Disorders,
Diabetes mellitus
Multiple Pregnancies
Positive Family History
Lab: Aminotransferases ≤ 20xULN
Bibleclass 23.09.2015, Brunner 6
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Hyperemesis Gravidarum
Bibleclass 23.09.2015, Brunner 7
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Hyperemesis Gravidarum
Complications:
Mother: Dehydration, AKI, Weight ⬇Wernicke Encephalopathy
Foetus: Low Birth Weight
Preterm Delivery
Bibleclass 23.09.2015, Brunner 7
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Hyperemesis Gravidarum
Complications:
Mother: Dehydration, AKI, Weight ⬇Wernicke Encephalopathy
Foetus: Low Birth Weight
Preterm Delivery
Therapy: Rehydration
Bibleclass 23.09.2015, Brunner 7
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Hyperemesis Gravidarum
Complications:
Mother: Dehydration, AKI, Weight ⬇Wernicke Encephalopathy
Foetus: Low Birth Weight
Preterm Delivery
Therapy: Rehydration
Antiemetics
Bibleclass 23.09.2015, Brunner 7
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Hyperemesis Gravidarum
Complications:
Mother: Dehydration, AKI, Weight ⬇Wernicke Encephalopathy
Foetus: Low Birth Weight
Preterm Delivery
Therapy: Rehydration
Antiemetics
Vitamin Supp. (e.g. B1!!)
Bibleclass 23.09.2015, Brunner 7
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Intrahepatic Cholestasis of
Pregnancy
Bibleclass 23.09.2015, Brunner 8
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Intrahepatic Cholestasis of
Pregnancy
Trimester: 2nd Half of Pregnancy
Bibleclass 23.09.2015, Brunner 8
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Intrahepatic Cholestasis of
Pregnancy
Trimester: 2nd Half of Pregnancy
Symptoms: Pruritus (particularly Soles & Palms)
Diarrhoea
Bibleclass 23.09.2015, Brunner 8
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Intrahepatic Cholestasis of
Pregnancy
Trimester: 2nd Half of Pregnancy
Symptoms: Pruritus (particularly Soles & Palms)
Diarrhoea
Jaundice
Bibleclass 23.09.2015, Brunner 8
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Intrahepatic Cholestasis of
Pregnancy
Trimester: 2nd Half of Pregnancy
Symptoms: Pruritus (particularly Soles & Palms)
Diarrhoea
Jaundice
Epidemiology: 0.1-1.5% all Pregnancies
Bibleclass 23.09.2015, Brunner 8
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Intrahepatic Cholestasis of
Pregnancy
Trimester: 2nd Half of Pregnancy
Symptoms: Pruritus (particularly Soles & Palms)
Diarrhoea
Jaundice
Epidemiology: 0.1-1.5% all Pregnancies
(Scandinavia & South America ⬆)
Bibleclass 23.09.2015, Brunner 8
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ICP - Pathogenesis
Bibleclass 23.09.2015, Brunner 9
Joshi, Lancet 2010
• 15% Mutation
MDR3 gene
(10 identified)
• Female
Hormones
Inhibit Bile Salt
Export Pumps
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ICP
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Positive Family History
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Positive Family History
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Positive Family History
Lab: Aminotransferases ≤ 20xULN
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Positive Family History
Lab: Aminotransferases ≤ 20xULN
Bile Acids > 10 µmol/L
Bibleclass 23.09.2015, Brunner 10
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ICP
Risk Factors: Intrahepatic Cholestasis due to
Contraceptive Drugs,
Positive Family History
Lab: Aminotransferases ≤ 20xULN
Bile Acids > 10 µmol/L
Bibleclass 23.09.2015, Brunner 10
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ICP
Bibleclass 23.09.2015, Brunner 11
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ICP
Complications:
Mother: Risk of Biliary &
Autoimmune Disease in the
Future
Foetus: Anoxia, Prematurity, Stillbirth,
Perinatal Death
Bibleclass 23.09.2015, Brunner 11
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ICP
Complications:
Mother: Risk of Biliary &
Autoimmune Disease in the
Future
Foetus: Anoxia, Prematurity, Stillbirth,
Perinatal Death
Therapy: Ursodeoxycholicacid
Bibleclass 23.09.2015, Brunner 11
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ICP
Complications:
Mother: Risk of Biliary &
Autoimmune Disease in the
Future
Foetus: Anoxia, Prematurity, Stillbirth,
Perinatal Death
Therapy: Ursodeoxycholicacid
10-15mg/kg
Bibleclass 23.09.2015, Brunner 11
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ICP
Complications:
Mother: Risk of Biliary &
Autoimmune Disease in the
Future
Foetus: Anoxia, Prematurity, Stillbirth,
Perinatal Death
Therapy: Ursodeoxycholicacid
10-15mg/kg
Early Delivery Week (36)-38
Bibleclass 23.09.2015, Brunner 11
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Pre-Eclampsia & Eclampsia
Bibleclass 23.09.2015, Brunner 12
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Pre-Eclampsia & Eclampsia
Trimester: 2nd Half of Pregancy
Bibleclass 23.09.2015, Brunner 12
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Pre-Eclampsia & Eclampsia
Trimester: 2nd Half of Pregancy
Definition: Pre-Eclampsia = AHT +
Proteinuria
Bibleclass 23.09.2015, Brunner 12
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Pre-Eclampsia & Eclampsia
Trimester: 2nd Half of Pregancy
Definition: Pre-Eclampsia = AHT +
Proteinuria
Eclampsia = Pre-Eclampsia
+ Seizures
Bibleclass 23.09.2015, Brunner 12
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Pre-Eclampsia & Eclampsia
Trimester: 2nd Half of Pregancy
Definition: Pre-Eclampsia = AHT +
Proteinuria
Eclampsia = Pre-Eclampsia
+ Seizures
Epidemiology: 5-10% all pregnancies
Bibleclass 23.09.2015, Brunner 12
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Pre-Eclampsia & Eclampsia
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Risk Factors: Age <16 or >45 years
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Risk Factors: Age <16 or >45 years
Primiparity
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Risk Factors: Age <16 or >45 years
Primiparity
Pre-existing AHT
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Risk Factors: Age <16 or >45 years
Primiparity
Pre-existing AHT
pos. Family History
Occurrence previous Pregnancy
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Mechanism: Placenta Ischemia
➡ Endothelial Dysfunction
& Coagulation Activation
Risk Factors: Age <16 or >45 years
Primiparity
Pre-existing AHT
pos. Family History
Occurrence previous Pregnancy
Bibleclass 23.09.2015, Brunner 13
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Pre-Eclampsia & Eclampsia
Bibleclass 23.09.2015, Brunner 14
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Pre-Eclampsia & Eclampsia
Complications:
Mother: Hypertensive Crises
Renal Dysfunction
Hepatic Rupture or InfarctionSeizures
Increased Morbidity & Mortality
Bibleclass 23.09.2015, Brunner 14
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Pre-Eclampsia & Eclampsia
Complications:
Mother: Hypertensive Crises
Renal Dysfunction
Hepatic Rupture or InfarctionSeizures
Increased Morbidity & Mortality
Therapy: Early Delivery, Magnesiumsulfate
Bibleclass 23.09.2015, Brunner 14
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HELLP
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Elevated Liver Enzymes
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Elevated Liver Enzymes
Low Platelets
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Elevated Liver Enzymes
Low Platelets
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Elevated Liver Enzymes
Low Platelets
Epidemiology: 0.6 % all Pregnancies
Bibleclass 23.09.2015, Brunner 15
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HELLP
Trimester: 2nd Half of Pregancy
Definition: Hemolysis
Elevated Liver Enzymes
Low Platelets
Epidemiology: 0.6 % all Pregnancies
5-10% Pre-Eclampsia
Bibleclass 23.09.2015, Brunner 15
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HELLP
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Risk Factors: Advanced Maternal Age
Multiparity
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Risk Factors: Advanced Maternal Age
Multiparity
Caucasian Ethnicity
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Risk Factors: Advanced Maternal Age
Multiparity
Caucasian Ethnicity
Lab: Hemolysis, Platelets ⬇
Bibleclass 23.09.2015, Brunner 16
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HELLP
Mechanism: Not Clear
Severe Form of Pre-Eclampsia?
Risk Factors: Advanced Maternal Age
Multiparity
Caucasian Ethnicity
Lab: Hemolysis, Platelets ⬇
Aminotransferases & Bilirubin ⬆
Bibleclass 23.09.2015, Brunner 16
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HELLP
Bibleclass 23.09.2015, Brunner 17
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HELLP
Bibleclass 23.09.2015, Brunner 18
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HELLP
Complications:
Mother: Hepatic Encephalopathy
Renal Failure
Hepatic Hematoma & Rupture
Hepatic Infarction
Child: Prematurity ➡ 6-70% mortality
Bibleclass 23.09.2015, Brunner 18
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HELLP
Bibleclass 23.09.2015, Brunner 19
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HELLP
Therapy: Early delivery (≥ week 34)
Bibleclass 23.09.2015, Brunner 19
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HELLP
Therapy: Early delivery (≥ week 34)
ICU
Bibleclass 23.09.2015, Brunner 19
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HELLP
Therapy: Early delivery (≥ week 34)
ICU
Antihypertensive Therapy
(Labetalolol, Hydralazin,
Nifedipin)
Bibleclass 23.09.2015, Brunner 19
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HELLP
Therapy: Early delivery (≥ week 34)
ICU
Antihypertensive Therapy
(Labetalolol, Hydralazin,
Nifedipin)
OLT in case of Liver Failure
Bibleclass 23.09.2015, Brunner 19
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Acute Fatty Liver of Pregnancy
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Symptoms: Vomiting, Jaundice,
Hypoglycemia,
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Symptoms: Vomiting, Jaundice,
Hypoglycemia,
Lactacidosis,
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Symptoms: Vomiting, Jaundice,
Hypoglycemia,
Lactacidosis,
Hyperammonaemia
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Symptoms: Vomiting, Jaundice,
Hypoglycemia,
Lactacidosis,
Hyperammonaemia
Epidemiology: 5/100’000 pregnancies
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Trimester: 3rd.
Symptoms: Vomiting, Jaundice,
Hypoglycemia,
Lactacidosis,
Hyperammonaemia
Epidemiology: 5/100’000 pregnancies
Bibleclass 23.09.2015, Brunner 20
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Acute Fatty Liver of Pregnancy
Bibleclass 23.09.2015, Brunner 21
Mechanism:
• Mitochondrial
Cytopathy
• The Fetus has a defect
Fatty acid β oxidation
• Deficient long-chain 3-
hydoxyacyl coenzyme A
dehydrogenase
Mother
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Acute Fatty Liver of Pregnancy
Bibleclass 23.09.2015, Brunner 22
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Acute Fatty Liver of Pregnancy
Complications:
Mother: Risk factor for development
of biliary & autoimmune
disease in the future
Foetus: Anoxia, prematurity, stillbirth,
perinatal death
Bibleclass 23.09.2015, Brunner 22
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Acute Fatty Liver of Pregnancy
Complications:
Mother: Risk factor for development
of biliary & autoimmune
disease in the future
Foetus: Anoxia, prematurity, stillbirth,
perinatal death
Therapy: Ursodeoxycholicacid
Bibleclass 23.09.2015, Brunner 22
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Acute Fatty Liver of Pregnancy
Complications:
Mother: Risk factor for development
of biliary & autoimmune
disease in the future
Foetus: Anoxia, prematurity, stillbirth,
perinatal death
Therapy: Ursodeoxycholicacid
10-15mg/kg
Bibleclass 23.09.2015, Brunner 22
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Acute Fatty Liver of Pregnancy
Complications:
Mother: Risk factor for development
of biliary & autoimmune
disease in the future
Foetus: Anoxia, prematurity, stillbirth,
perinatal death
Therapy: Ursodeoxycholicacid
10-15mg/kg
Early delivery week (36)-38
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Acute Fatty Liver of PregnancySwansea Diagnostic
Criteria Risk Factors:
• Twin pregnancy
• Nulliparity
• Inverse Relation
between BMI & AFLP
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Acute Fatty Liver of Pregnancy
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Acute Fatty Liver of Pregnancy
Complications:
Mother: Hepatic Encephalopathy
Liver Failure, Liver Rupture
Renal Failure
Maternal Mortality 1-20%
Child: Features associated
with defect fatty acid oxidation:
Hypoglycaemia, Hepatic failure,
MyopathyBibleclass 23.09.2015, Brunner 24
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HBV Transmission
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HBV Transmission
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HBV Transmission
Background:
• Switzerland:
0.5% of Pregnant Women
HBs-Antigene positive
• Mother-to-Child-Transmission:- HBe-Ag positive: 70-90%
- HBe-Ag negative: 10-40%
- Acute Hepatitis B in Pregnancy: 40-60%
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HBV Transmission
Background:
• Postnatal Hepatitis B Immunoglobulin
& HBV Vaccine reduces Transmission to 5-10%
• Predictive for Immunoprophylaxis Failure
HBe-Antigen positive
HBV DNA > 200‘000 IU/ml
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HBV Transmission
Bibleclass 23.09.2015, Brunner 29Bleich, J Clin Gastr 2014
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