科研之友
微信
新浪微博
Facebook
分享链接
摘要
BACKGROUND: Autoimmune hepatitis (AIH) is a progressive chronic hepatitis of unknown cause that occurs in children and adults, with a paucity of information of this disorder existing in pregnancy.
CASE: A primigravid patient presented at 30 weeks with altered mental status, abdominal pain, vomiting, and epistaxis. Her history was significant for portal hypertension, encephalopathy, ascites, coagulopathy, hyperammonemia, and end-stage liver disease secondary to AIH. Ultrasound revealed cirrhosis, ascites, splenomegaly, and an appropriately grown singleton gestation. She received 2 intramuscular doses of betamethasone over 24 hours, subcutaneous vitamin K, and oral prednisone. A lower extremity venous Doppler study was negative for thrombosis. She received ceftriaxone 1 g daily x 5 days to treat spontaneous bacterial peritonitis. A unit of packed red blood cells and 1 unit of platelets were transfused prior to a primary cesarean 2 weeks after the initial presentation. Postoperative agitation was managed with risperidone, and wound infection was treated with vancomycin/metronidazole. She discharged herself against medical advice on postoperative day 15, and the infant was discharged to foster care on day 15 of life.
CONCLUSION: Multiple management challenges usually arise in pregnancies complicated by end-stage liver disease. However, with comprehensive multidisciplinary care a successful perinatal outcome can be accomplished.
- 出版日期2016-10
