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Pregnancy complicated with hepatitis A
The symptoms are the same as those of non-pregnant women, and the onset is urgent. Besides digestive tract symptoms and jaundice, the positive anti-HAV-IgM in serological examination can be confirmed.
Pregnancy complicated with hepatitis B
(1) Have digestive system symptoms
(Nausea, vomiting), fatigue, jaundice, etc., with acute onset and elevated serum ALT.
(2) Serological detection indexes:
① Hepatitis B surface antigen (HBsAg):
As the most commonly used index of hepatitis B infection, HBsAg can be positive before incubation period infection and serum ALT increase; When HBsAg is high titer, e-antigen (HBeAg) is also positive. It is not enough to use single HBsAg as infection index in clinic, but should be judged by combining with clinical manifestations and other indexes.
② Hepatitis B surface antibody (anti-HBs):
It is a protective antibody. When acute hepatitis B virus infection occurs, after a period of time, anti-HBs indicates that the body has acquired immunity.
③ Hepatitis B E antigen (HBeAg):
HBeAg is a degradation product of HBcAg, HBeAg appears a little later than HBsAg in acute infection, and subtypes e1 and e2 of e antigen reflect the replication activity of hepatitis B virus more.
④ Hepatitis B E antibody (anti-HBe):
Generally, when HBeAg disappears in blood, and then anti-HBe appears, it indicates that virus replication is reduced, infectivity is reduced, and the condition is gradually stable.
⑤ Core antibody (anti-HBc):
In acute infection, HBsAg can be detected 2 ~ 4 weeks after the appearance of HBsAg and before the appearance of clinical symptoms, so anti-HBC-IgM is more common in the early stage of infection or the active stage of chronic infection.
⑥ Hepatitis B virus DNA (HBV-DNA):
HBV-DNA positive is the direct evidence of HBV replication and infectious index. HBV-DNA is balanced with HBeAg and DNA-polymerase. HBV-DNA can be detected in 86% ~ 100% of HBeAg positive blood.
According to clinical symptoms, signs, liver function and serological indicators, the diagnosis of pregnancy complicated with hepatitis B can be quickly defined.
Serological diagnosis of intra-fetal infection of hepatitis B virus should pay attention to the following three basis:
(1) HBsAg positive in umbilical cord serum of newborns can be used as a reference index.
(2) HBcAb-IgM positive in umbilical cord serum of newborns can confirm intrauterine infection.
(3) If there is a condition to test umbilical cord serum, hepatitis B virus DNA is positive, it can be confirmed, but this index can not be popularized and applied in China.
Pregnancy complicated with severe hepatitis
Second, diagnostic criteria
The onset is sharp, the poisoning symptoms are obvious, and the jaundice is serious.
(1) Serum bilirubin was more than 171 μ mol/L (10mg/dl) within one week, or increased daily by more than 17.1 μ mol/L (1mg/dl).
(2) Prothrombin time was obviously prolonged, which was 0.5 ~ 1 times or even longer than the normal value.
(3) There are different degrees of hepatic coma, and severe cases may have liver odor.
(4) Ascites may appear or even the liver dullness boundary shrinks.
Influence of pregnancy complicated with hepatitis A
Effect of hepatitis A on perinatal infants; According to the data of Shanghai No.1 Maternal and Infant Health Hospital, Pregnancy outcome of hepatitis A parturient in the second and third trimester, The perinatal mortality rate is 42.3 ‰ and 125 ‰ respectively, that is, the perinatal mortality rate in the third trimester of pregnancy is obviously increased. Compared with the perinatal mortality rate of normal parturients in Shanghai in the same year, there is a significant difference between them. Although there is no maternal death due to hepatitis A, the high perinatal mortality rate is a problem that can not be ignored.
Influence of pregnancy complicated with hepatitis B
Influence of hepatitis B on pregnancy; Abortion, premature birth, stillbirth, stillbirth, neonatal asphyxia and neonatal mortality rate of pregnant women with hepatitis B are obviously increased, which is related to acute icteric hepatitis, especially severe or even fulminant hepatitis in the third trimester of pregnancy. The mortality rate of fulminant hepatitis in pregnant women is higher than that in non-pregnant women, and fulminant hepatitis is especially easy to occur during pregnancy, especially in the second trimester of pregnancy.
Effect of pregnancy on viral hepatitis: Some people think that non-specific hypersensitivity reaction is easy to occur during pregnancy, and pregnancy is in the preparation state of non-specific hypersensitivity reaction, so the probability of severe or fulminant hepatitis increases significantly during pregnancy. Animal experiments have proved that acute liver necrosis of pregnant rabbits is more serious before and after delivery. Therefore, in recent years, it is advocated that in early pregnancy, such asHigh HBsAg titer and positive HBeAg can be induced abortion. In the third trimester of pregnancy, due to the relative lack of liver blood flow, the liver blood flow is relatively reduced after hepatitis, which can aggravate hepatitis and even become severe hepatitis.
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