LFT in pregancy

LFT in pregancy : In normal   pregnancy    serum AST   and ALT  levels   are slightly  lower compared  to non pregnant   normal values   whereas serum  alkaline  phosphate levels   almost double. Viral    hepatitis is one of the commonest liver disease  incidental   to pregnancy   . Hepatitis A and E are transmitted by fecooral route whereas B,D and G are transmitted parentally. Hepatitis A  virus   infection recovers    completely  without any residual    disease., the  clinical   course   of most of the  viral hepatitis  is unaffected by   pregnancy    except  Hepatitis  E and  disseminated   herpes   simplex  hepatitis.

Viral    hepatitis  during  pregnancy is not an indication  for termination   of pregnancy   or  cesarean section.

Breastfeeding   is not contraindicated in viral   hepatitis. 

Newborns  of mothers with hepatitis A virus   infection in 3^rd trimester    should be given passive    immunoprophylaxis  at birth. 

Hepatitis E virus   infection in pregnancy may manifest as  severe   illness  with frequent    fulminant hepatitis.  There  is increased risk of  miscarriage    preterm   labor and stillbirth.  There is  high risk of  maternal  fetal and neonatal     morbidity   and mortality    with Hepatitis    E virus  infection   in pregnancy     There  is 90%   risk of vertical  transmission  from hepatitis B infected  mother to   her fetus  if she is HBeAg positive   at the time of delivery . Prevention   of neonatal infection in babies of Hepatitis B infected   mothers   is with active and passive  immunoprophylaxis  within  12 hrs  of birth.

In mothers    with hepatitis c virus   infection risk    factors  for vertical transmission  are high levels    of hepatitis  C RNA   in maternal blood. HIV   co infection , increased    interval between   membrane  rupture    and delivery  . Risk of transmission to the fetus    can be minimized by  avoiding   fetal scalp    monitoring  and prolonged   labor     after    rupture  of  membrane. Non   cirrhotic partal hypertension is associated with lower  maternal mortality rates   during   episodes of variceal hemorrhage compared to cirrhotic   portal  hypertension .

In pregnant    patients with   known large  esophageal    varices elective   cesarean  is  recommended . The second    stage   of labor should  be cut short   with forceps    in other   women with portal  hypertension.

Pregnant    patients   with chronic  liver disease are    at high risk of postpartum  hemorrhage   due to associated  coagulopathy    and thrombocytopenia. 

Recommended mode of  delivery    is vaginal   in most of the cases  of liver   disease   except those   with large   esophageal  varices.

Pregnancy    should    preferably be postponed for 2 years   after  liver transplantation for better   prognosis.

Pregnant    patients who   have   undergone  liver  transplantation   previously should  be advised  to continue taking  immunosuppressive    drugs  as there  is risk   of acute  graft  rejection.