Skip to main content

Advertisement

SpringerLink
Log in

Lebererkrankungen in der Schwangerschaft

Hepatic diseases in pregnancy

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Gastroenterologe Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Airoldi J, Berghella V (2006) Hepatitis C and pregnancy. Obstet Gynecol Surv 61: 666–672

    Article  PubMed  Google Scholar 

  2. Bacq Y (1998) Acute fatty liver of pregnancy. Semin Perinatol 22: 134–140

    Article  PubMed  CAS  Google Scholar 

  3. Bani Hani MN, Bani-Hani KE, Rashdan A et al (2009) Safety of endoscopic retrograde cholangiopancreatography during pregnancy. ANZ J Surg 79: 23–26

    Article  Google Scholar 

  4. Boccia D, Guthmann JP, Klovstad H et al (2006) High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 42: 1679–1684

    Article  PubMed  Google Scholar 

  5. Chong VH, Jalihal A (2010) Endoscopic management of biliary disorders during pregnancy. Hepatobiliary Pancreat Dis Int 9: 180–185

    PubMed  Google Scholar 

  6. Conte D, Fraquelli M, Prati D et al (2000) Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 31: 751–755

    Article  PubMed  CAS  Google Scholar 

  7. Corpechot C, Chretien Y, Chazouilleres O et al (2010) Demographic, lifestyle, medical and familial factors associated with primary biliary cirrhosis. J Hepatol 53: 162–169

    Article  PubMed  Google Scholar 

  8. Dalton HR, Bendall R, Ijaz S et al (2008) Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis 8: 698–709

    Article  PubMed  Google Scholar 

  9. Dupont P, Irion O, Beguin F (1990) Pregnancy in a patient with treated Wilson’s disease: a case report. Am J Obstet Gynecol 163: 1527–1528

    PubMed  CAS  Google Scholar 

  10. Glantz A, Marschall HU, Mattsson La (2004) Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology 40: 467–474

    Article  PubMed  Google Scholar 

  11. Graham G, Baxi L, Tharakan T (1998) Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature. Obstet Gynecol Surv 53: 566–574

    Article  PubMed  CAS  Google Scholar 

  12. Gupta I, Ratho RK (2003) Immunogenicity and safety of two schedules of Hepatitis B vaccination during pregnancy. J Obstet Gynaecol Res 29: 84–86

    Article  PubMed  Google Scholar 

  13. Hay JE (2008) Liver disease in pregnancy. Hepatology 47: 1067–1076

    Article  PubMed  Google Scholar 

  14. Ibdah JA, Yang Z, Bennett MJ (2000) Liver disease in pregnancy and fetal fatty acid oxidation defects. Mol Genet Metab 71: 182–189

    Article  PubMed  CAS  Google Scholar 

  15. Janczewska I, Olsson R, Hultcrantz R et al (1996) Pregnancy in patients with primary sclerosing cholangitis. Liver Int 16: 326–330

    Article  CAS  Google Scholar 

  16. Jonas MM (2009) Hepatitis B and pregnancy: an underestimated issue. Liver Int 29 (Suppl 1): 133–139

    Article  PubMed  Google Scholar 

  17. Joshi D, James A, Quaglia A et al (2010) Liver disease in pregnancy. Lancet 375: 594–605

    Article  PubMed  Google Scholar 

  18. Lee NM, Brady CW (2009) Liver disease in pregnancy. World J Gastroenterol 15: 897–906

    Article  PubMed  Google Scholar 

  19. Mackillop L, Williamson C (2010) Liver disease in pregnancy. Postgrad Med J 86: 160–164

    Article  PubMed  CAS  Google Scholar 

  20. Martin JN, Blake PG, Lowry SL et al (1990) Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery? Obstet Gynecol 76: 737–741

    Article  PubMed  Google Scholar 

  21. Pischke S, Potthoff A, Hauroder B et al (1946) Hepatitis E virus infection: a paradigm shift? Dtsch Med Wochenschr 135: 1129–1133

    Article  Google Scholar 

  22. Roberts EA, Schilsky ML (2003) A practice guideline on Wilson disease. Hepatology 37: 1475–1492

    Article  PubMed  Google Scholar 

  23. Schramm C, Herkel J, Beuers U et al (2006) Pregnancy in autoimmune hepatitis: outcome and risk factors. Am J Gastroenterol 101: 556–560

    Article  PubMed  CAS  Google Scholar 

  24. Sullivan CA, Magann EF, Perry KG Jr et al (1994) The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations. Am J Obstet Gynecol 171: 940–943

    PubMed  CAS  Google Scholar 

  25. Theodoridis TD, Zepiridis L, Athanatos D et al (2009) Placenta abruption in a woman with Wilson’s disease: a case report. Cases J 2: 8699

    Article  PubMed  Google Scholar 

  26. Tran TT (2009) Management of hepatitis B in pregnancy: weighing the options. Cleve Clin J Med 76(Suppl 3): S25–S29

    Article  PubMed  Google Scholar 

  27. Usta IM, Barton JR, Amon EA et al (1994) Acute fatty liver of pregnancy: an experience in the diagnosis and management of fourteen cases. Am J Obstet Gynecol 171: 1342–1347

    PubMed  CAS  Google Scholar 

  28. Wang J, Zhu Q, Zhang X (2002) Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis. Chin Med J (Engl) 115: 1510–1512

    Google Scholar 

  29. Wellge BE, Sterneck M, Teufel A et al (2011) Pregnancy in primary sclerosing cholangitis. Gut (Epub ahead of print)

  30. Xu WM, Cui YT, Wang L et al (2009) Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 16: 94–103

    Article  PubMed  Google Scholar 

Download references

Interessenskonflikt

Die Autoren geben an, dass kein Interessenskonflikt besteht.

Author information

Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    K. Schulze & S. Lüth

Authors
  1. K. Schulze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Lüth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Schulze.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-011-0571-8

Schlüsselwörter

Keywords

Search

Navigation