What are the diagnostic criteria for liver damage during pregnancy?

Women who are pregnant are more fragile and may have many problems at this time, such as easy infection. Their resistance is very poor at this time, so they need to be protected in all aspects. If liver damage occurs during pregnancy, the situation may be more serious. This will definitely affect the pregnancy and even directly endanger the health of the fetus. So what are the clinical diagnostic criteria for liver damage during pregnancy?

Diagnostic criteria for liver damage during pregnancy:

There is nothing special about the diagnosis of hepatitis during pregnancy, but obstetricians and gynecologists should be vigilant. Pregnant women who experience gastrointestinal symptoms or extreme fatigue during pregnancy should undergo a comprehensive physical examination and necessary liver function tests to determine whether it is a normal pregnancy or a hepatitis virus infection. The following points should be noted when diagnosing viral hepatitis during pregnancy: ① Pregnant women already have gastrointestinal symptoms such as nausea and vomiting, and these symptoms often worsen after contracting viral hepatitis. ② Liver function tests showed severe liver damage and the possibility of concurrent viral hepatitis. ③ One or more viral hepatitis serum indicators are positive. ④ Before pregnancy, the woman was a carrier of the hepatitis B, C, or D viruses, and is very likely to suffer from liver damage and hepatitis after pregnancy. ⑤ Viral hepatitis during pregnancy is more serious, especially in the late pregnancy, when the proportion of severe liver disease is high and the mortality rate is also high. The severity of the disease is closely related to the duration of pregnancy (late pregnancy > mid pregnancy > early pregnancy). According to data from 60 cases of pregnancy complicated with hepatitis reported by Tongji Medical College, the prevalence of severe liver disease was 23.33%, significantly higher than that of the non-pregnant group (8%). The mortality rate was 18.3%, while that of the non-pregnant group was 5.5%. There was a significant difference between the two groups. There were 31 cases of late pregnancy hepatitis, 8 of which were severe liver disease and 7 died. This indicates that the prognosis of hepatitis in late pregnancy is serious.

Differential diagnosis of viral hepatitis during pregnancy:

Viral hepatitis during pregnancy should be differentiated from the following diseases:

1. Liver disease caused by pregnancy poisoning: occurs after 20 weeks of pregnancy, with systemic arteriolar spasm as the main change. Edema, hypertension, proteinuria, increased uric acid, creatinine, and urea nitrogen, and abnormal liver function may occur. Hepatitis during pregnancy generally does not cause hypertension and proteinuria, jaundice is common, and viral serum indicators are positive.

2. Intrahepatic cholestasis of pregnancy:

3. Acute fatty liver of pregnancy:

Prevention and treatment of viral hepatitis during pregnancy:

The prevention and treatment measures for viral hepatitis during pregnancy include the following aspects:

1. Prevention is the priority. Pregnant women can be vaccinated against hepatitis B and A;

2. For hepatitis B, C, and D virus carriers, in addition to paying attention to rest and nutrition, their liver function changes should be closely observed;

3. Mild chronic liver disease has little effect on pregnancy, but liver function should be checked regularly. If symptoms worsen and liver function is obviously damaged, hospitalization is required. Patients with moderate to severe chronic liver disease are often unable to become pregnant. Occasionally, liver disease may worsen during pregnancy, and the mortality rate is very high. Women with cirrhosis are generally not suitable for pregnancy, as liver function may be severely damaged after pregnancy. The maternal mortality rate can reach 10.5%, and deaths are often caused by liver failure, rupture of esophageal varicose veins, or massive bleeding caused by coagulation disorder. And the rate of fetal miscarriage and stillbirth is high.

4. Pregnant women are susceptible to hepatitis E infection and have more severe symptoms, especially in late pregnancy. The mortality rate is more than 10 times higher than hepatitis A, reaching 10-40%, so special vigilance should be exercised.

5. The treatment principles for viral hepatitis during pregnancy are the same as those for general viral hepatitis. Because it is more likely to develop into severe hepatitis, early diagnosis and treatment must be paid attention to, and patients with hepatitis in late pregnancy should be admitted to the hospital for treatment in a timely manner. Be fully prepared for delivery, pay attention to postpartum hemorrhage, and use antibiotics in time before and after delivery to prevent infection. Those with severe liver disease should be treated as those with severe hepatitis.

6. Regarding termination of pregnancy due to viral hepatitis during pregnancy: In principle, early pregnancy can be continued, and those who do not want to keep the fetus can have an abortion. It is generally not advisable to terminate the pregnancy in the middle or late stages of pregnancy. Both surgery and anesthesia can aggravate liver damage. If a pregnant woman's liver disease worsens or the fetus dies in utero, and it is estimated that she cannot continue the pregnancy, she should actively terminate the pregnancy. The method of termination of pregnancy depends on the mother's condition. If the fetus can be saved, a cesarean section is performed; otherwise, induced labor is appropriate.