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Lebererkrankungen in der Schwangerschaft

Hepatic diseases in pregnancy

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Zusammenfassung

Die physiologisch bedingten Leberwerterhöhungen in der Schwangerschaft müssen von Lebererkrankungen abgegrenzt werden. Hierbei sind schwangerschaftsassoziierte von zufällig mit einer Schwangerschaft einhergehenden Lebererkrankungen wie Gallensteine, autoimmune Hepatitis, primär biliäre Zirrhose, primär sklerosierende Cholangitis, Morbus Wilson, Hepatitis B und C sowie Leberzirrhose zu unterscheiden. Zur Gruppe der schwangerschaftsassoziierten Lebererkrankungen zählen die Hyperemesis gravidarum, die intrahepatische Schwangerschaftscholestase, die akute Schwangerschaftsfettleber, das HELLP-Syndrom (hemolysis, elevated liver tests, low platelet count) sowie die Präeklampsie/Eklampsie. Die Behandlung sollte interdisziplinär zwischen Hepatologen und Geburtshelfern erfolgen. Bei schwangerschaftsassoziierten Lebererkrankungen beinhaltet dies oft die zeitnahe Geburtseinleitung, während bei zufällig mit einer Schwangerschaft einhergehenden Lebererkrankungen die bestmögliche Einstellung der Grunderkrankung – unter Berücksichtigung des Embryos bzw. Fetus – im Vordergrund steht.

Abstract

In pregnancy physiologically induced altered levels in liver function tests have to be distinguished from liver diseases. These can be divided into clearly pregnancy-associated and liver diseases coincidentally occurring with pregnancy, such as gall-stones, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease, hepatitis B and C infections and cirrhosis of the liver. Pregnancy-associated liver diseases include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia/eclampsia, the hemolysis, elevated liver tests and low platelets (HELLP) syndrome and acute fatty liver of pregnancy. A close collaboration between obstetricians and hepatologists is recommended. In terms of pregnancy-related entities this often means prompt delivery of the neonate, whereas in pregnancy-independent liver diseases best supportive care including supervision of the embryo/fetus has priority.

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Die Autoren geben an, dass kein Interessenskonflikt besteht.

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Correspondence to Dr. K. Schulze.

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Schulze, K., Lüth, S. Lebererkrankungen in der Schwangerschaft. Gastroenterologe 6, 337–346 (2011). https://doi.org/10.1007/s11377-011-0571-8

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Schlüsselwörter

  • Schwangerschaft
  • Erhöhte Leberwerte
  • Intrahepatische Schwangerschaftscholestase
  • HELLP-Syndrom
  • Akute Schwangerschaftsfettleber

Keywords

  • Pregnancy
  • Elevated liver function tests
  • Intrahepatic cholestasis of pregnancy
  • HELLP syndrome
  • Acute fatty liver of pregnancy