Zusammenfassung
In diesem Kapitel werden die Leberkrankheiten in der Schwangerschaft, insbesondere die intrahepatische Schwangerschaftscholestase, das HELLP-Syndrom und die akute Schwangerschaftsfettleber, die einen häufigen Konsultationsgrund im hepatologischen Alltag darstellen, beschrieben. Da diese Lebererkrankungen Mutter und Kind gefährden können, verlangen sie eine interdisziplinäre strukturierte und zuverlässige Abklärung Die Diagnose einer schwangerschaftsspezifischen Leberkrankheit erfordert den Ausschluss von ko- und präexistenten Leberkrankheiten. In Einzelfällen liefert eine Leberbiopsie zusätzliche Informationen, insbesondere, wenn die Hepatopathie post partum persistiert.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Literatur
Bacq Y, Gendrot C, Perrotin F, Lefrou L, Chrétien S, Vie-Buret V, Brechot MC, Andres CR (2009) ABCB4 gene mutations and single-nucleotide polymorphisms in women with intrahepatic cholestasis of pregnancy. J Med Genet 46:711–715
Bacq Y, Sentilhes L, Reyes HB, Glantz A, Kondrackiene J, Binder T, Nicastri PL, Locatelli A, Floreani A, Hernandez I, Di Martino V (2012) Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis. Gastroenterology 143:1492–1501
Berg B, Helm G, Petersohn L, Tryding N (1986) Cholestasis of pregnancy. Clinical and laboratory studies. Acta Obstet Gynecol Scand 65:107–113
Beuers U, Boberg KM, Chapman RW, Chazouillères O, Invernizzi P, Jones DE, Lammert F, Parès A, Trauner M (2009) European Association for the Study of the Liver Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol 51:237–267
Ch’ng CL, Morgan M, Hainsworth I, Kingham JG (2002) Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 51:876–880
Dani R, Mendes GS, Medeiros Jde L, Péret FJ, Nunes A (1996) Study of the liver changes occurring in preeclampsia and their possible pathogenetic connection with acute fatty liver of pregnancy. Am J Gastroenterol 91:292–294
Dixon PH, Wadsworth CA, Chambers J, Donnelly J, Cooley S, Buckley R, Mannino R, Jarvis S, Syngelaki A, Geenes V, Paul P, Sothinathan M, Kubitz R, Lammert F, Tribe RM, Ch’ng CL, Marschall HU, Glantz A, Khan SA, Nicolaides K, Whittaker J, Geary M, Williamson C (2014) A comprehensive analysis of common genetic variation around six candidate loci for intrahepatic cholestasis of pregnancy. Am J Gastroenterol 109:76–84
Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, Kohari K, Bacq Y, Bozkurt N, Brun-Furrer R, Bull L, Estiú MC, Grymowicz M, Gunaydin B, Hague WM, Haslinger C, Hu Y, Kawakita T, Kebapcilar AG, Kebapcilar L, Kondrackienė J, Koster MPH, Kowalska-Kańka A, Kupčinskas L, Lee RH, Locatelli A, Macias RIR, Marschall HU, Oudijk MA, Raz Y, Rimon E, Shan D, Shao Y, Tribe R, Tripodi V, Yayla Abide C, Yenidede I, Thornton JG, Chappell LC, Williamson C (2019) Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 393:899–909
Glantz A, Marschall HU, Mattsson LA (2004) Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 40:467–474
Guth C, Beuers U, Beckh K (2016) Eine 22 jährige Mutter mit starkem Juckreiz und zunehmendem Ikterus zwei Wochen nach Beginn der hormonalen Kontrazeption. Z Gastroenterol 54:1076–1080
Ibdah JA, Bennett MJ, Rinaldo P, Zhao Y, Gibson B, Sims HF, Strauss AW (1999) A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women. N Engl J Med 340:1723–1731
Ibdah JA, Hammoud GM (2014) Preeclampsia-induced liver dysfunction, HELLP syndrome, and acute fatty liver of pregnancy. Clin Liver Dis 4:69–73
Jacquemin E, Cresteil D, Manouvrier S, Boute O, Hadchouel M (1999) Heterozygous non-sense mutation of the MDR3 gene in familial intrahepatic cholestasis of pregnancy. Lancet 353:210–211
Schlembach D, Stepan H, Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2019) S2k-Leitlinie Hypertensive Schwangerschaftserkrankungen: Diagnostik und Therapie. AWMF-Register-Nr. 015/018. https://www.awmf.org/uploads/tx_szleitlinien/015-018l_S2k_Diagnostik_Therapie_hypertensiver_Schwangerschaftserkrankungen_2019-07.pdf (letztes Zugriffsdatum 18.02.2020)
Lammert F, Marschall HU, Glantz A, Matern S (2000) Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol 33:1012–1021
Lammert F, Liebe R, Arrese M (2013) Intrahepatic cholestasis of pregnancy: proposal for an updated classification based on genetics. In: Häussinger D, Beuers U, Trauner M (Hrsg) Hepatic and extrahepatic targets of bile acid signaling. XXII. International Bile Acid Meeting. Karger, Basel, S 83–87
Lammert F (2016) Lebererkrankungen. In: Kainer FK (Hrsg) Facharzt Geburtsmedizin, 3. Aufl. Urban & Fischer, München, Jena, S 450–472
Reyes H, Sjövall J (2000) Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann Med 32:94–106
Reyes H (2016) What have we learned about intrahepatic cholestasis of pregnancy? Hepatology 63:4–8
Royal College of Obstetricans and Gynaecologists (2006) Obstetric Cholestasis. Guideline No. 43, S 1–10
Thaler H (1969) Leberbiopsie. Ein klinischer Atlas der Histopathologie. Springer, Berlin, Heidelberg, S. 121
Vigil-de Gracia P, Montufar-Rueda C (2011) Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases. J Matern Fetal Neonatal Med 24:1143–1146
Wendum D, Barbu V, Rosmorduc O, Arrivé L, Fléjou JF, Poupon R (2012) Aspects of liver pathology in adult patients with MDR3/ABCB4 gene mutations. Virchows Arch 460:291–298
Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, Marschall HU (2015) Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: a population-based cohort study. J Hepatol 63:456–461
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature
About this chapter
Cite this chapter
Lammert, F. (2020). Leber und Schwangerschaft. In: Tannapfel, A., Klöppel, G. (eds) Pathologie. Pathologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-04557-8_12
Download citation
DOI: https://doi.org/10.1007/978-3-642-04557-8_12
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-04556-1
Online ISBN: 978-3-642-04557-8
eBook Packages: Medicine (German Language)