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FRANZCOG OBSTETRICS > Liver disease pregnancy > Flashcards

Liver disease pregnancy Flashcards

1
Q

Risk of chronic carriage of Hep B if infected at delivery?

A

90%

subsequent cirrhosis and hepatocellular carcinoma

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2
Q

Risk of Hep B vertical transmission related to antigen status.

A

HBsAg +, HbeAg+ = 95%
HBsAg +, HBeAg- = 2-15%

Measurement of HBV DNA has replaced HBeAG as most sensitive test of viral activity.

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3
Q

Risk of HBV transplacental transmission?

A

5%

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4
Q

List significance of following ab/ag presence:

  1. HBsAb
  2. HBsAg
  3. HBcAb
  4. HBeAg
A
  1. vaccination or previous infection
  2. infected
  3. natural infection previously
  4. active viral replication
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5
Q

Risk of chronic infection after HBV exposure in adults?

A

10%. 25% of those develop chronic liver disease.

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6
Q

When is tenofovir indicated antenatally?

A

third trimester

HBV DNA >200,000IU/mL or 10^6 log copies/mL

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7
Q

What is the effect of antenatal tenofovir on infant infection?

A

RR 0.15 SS

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8
Q

Neonatal HBV immunisation consists of:

A
  1. HBIG <12 hrs after delivery
  2. DTAP <12 hours after delivery
  3. DTAP 6w, 3m, 5m

Reduces risk of infection RR0.08
Less effective if LBW or preterm.

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9
Q

Risk factors for hepatitis C?

A

80% of IVDU or blood product dependent patients

<5% sexually transmitted.

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10
Q

Course of hepatitis C infection in adults?

A

15-30% of untreated patients develop cirrhosis within 20 years
27% of those will develop hepatocellular carcinoma in 10 years.

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11
Q

Determinate of Hepatitis C vertical transmission ?

A

HCV viral load
1% RNA negative mothers
5% RNA positive mothers

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12
Q

Management of HCV in pregnancy

A

direct acting antivirals pre conceptually + treatment
DAA contraindicated antenatally
NIPT/MSS1 (no invasive tests if possible)
Avoid FSE/FBS
Bfing. Start DAA after finished + contraception.
No vaccines for HCV prevention.

No increase risk of congenital abnormalities, miscarriage or prematurity. Detection of infant infection reliable 3mo PP.

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13
Q

Prevalence of obstetric cholestasis?

A

0.7%

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14
Q

Risk factors for obstetric cholestasis?

A

family (autosomal dominant inheritance)
hep C carriage
gallstones
multiple pregnancy

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15
Q

Genetic pathology of obstetric cholestasis

A

MDR3 gene- hepatocellular transport system
lower oestriol circulates
bile salts accumulate—> vasoconstriction
dyslipidaemia
hyperbilirubinaemia

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16
Q

liver autoantibody screen?

A

anti-mitochondrial, anti-smooth muscle antibodies

17
Q

Perinatal mortality/morbidity associated with obstetric cholestasis?

A 
mortality = 1.1-3.5% (used to be 11%)
stillbirth= 1.5%
intrapartum fetal distress = 2-22%
fetal arrhythmia
preterm birth 25%
meconium 44%
vitamin K deficiency (intracranial haemorrhage)
18
Q

Maternal intrapartum risks of obstetric cholestasis

A

LSCS fetal distress
PTB
PPH 2-22%

19
Q

When would UCDA be prescribed for cholestasis?

A

non significant improvement in maternal itch scores. does not seem to effect any other perinatal/maternal outcomes.

20
Q

Evidence for timing of delivery with peak BS <100

A

no difference in stillbirth rate compared with background population risk before 39 weeks gestation.

BS >100 individualise timing. HR 30.50 stillbirth. May be reasonable to consider timing ~36 weeks.

21
Q

Delivery considerations of cholestasis?

A 
What was the peak BS level
LFTs
BP monitoring 
CTG in induction/labour
active management 3rd stage
coagulation profile at start (vitamin K if PTT prolonged)
IVL
Neonatal vitamin K
Avoid oestrogen OC's
Repeat LFT >10/7.
22
Q

Risk of AFLP in pregnancy?

A

1/7000-20,000

23
Q

Risk factors AFLP

A

male fetus (3:1)
primigravida
multiple preganncy
homozygous genetic defect in child (LCHAD deficiency)

24
Q

LCHAD function

A

catalyses step in beta oxidation of mitochondrial fatty acid
instead unmetabolised long-chain fatty acids spill into maternal circulation
leads to hepatotoxicity

LCHAD def also impairs placental vasopressinase enzyme degradation. Increases ADH= polydipsia, polyuria.

25
Q

maternal mortality and perinatal mortality of AFLP?

A 
maternal = 7%
fetal = 15%
26
Q

serum findings AFLP?

A 
Abnormal coags
lft deranged
wcc elevated, plt low
BSL low
hypocholesterolaemia
27
Q

Define HELLP syndrome

A

haemolysis
elevated liver ensyme
low platelets
unclear if on spectrum with PET or seperate

28
Q

Prevalence of HELLP?

A

1%

5-20% of pregnancies with PET.

29
Q

Difference of HELLP and HUS

A 
HUS
no jaundice, 
no neurological symptoms. 
AST/ALT normal. LDH elevated. 
Hypertension is not common. 
Severe AKI

HELLP
LDH may be elevated, but not profoundly
AST/ALT elevated

30
Q

Liver complications of HELLP?

A

liver rupture
sub capsular haematoma
massive hepatic necrosis

31
Q

Live birth rate after liver transplant?

A

92%

Increased PTB, FGR, NICU

32
Q

Prevalence of asymptomatic gallstones and cholecystitis in pregnancy?

A

2.5-10%

1/1000 have cholecystitis.

33
Q

What may prompt cholecystitis in pregnancy?

A

stones due to more bile cholesterol/less bile acid

gallbladder stasis

34
Q

Swansea criteria? (8)

A

raised

  • bilirubin
  • urate
  • WCC
  • ALT/AST
  • ammonia
  • creatinine

low
- glucose

  • coagulopathy

(cc wat bug)

FRANZCOG OBSTETRICS (25 decks)

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