Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis

OBJECTIVE: The purpose of this study was to determine whether routine hepatitis C virus screening in pregnancy is cost-effective. STUDY DESIGN: A decision tree with Markov analysis was developed to compare 3 approaches to asymptomatic hepatitis C virus infection in low-risk pregnant women: (1) no hepatitis C virus screening, (2) hepatitis C virus screening and subsequent treatment for progressive disease, and (3) hepatitis C virus screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission. Lifetime costs and quality-adjusted life years were evaluated for mother and child. RESULTS: In our base case, hepatitis C virus screening and subsequent treatment of progressive disease was dominated (more costly and less effective) by no screening, with an incremental cost of 108 US dollars and a decreased incremental effectiveness of 0.00011 quality-adjusted life years. When compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was 117 US dollars and 0.00010 quality-adjusted life years, respectively, which yields a cost-effectiveness ratio of 1,170,000 US dollars per quality-adjusted life year. CONCLUSION: The screening of asymptomatic pregnant women for hepatitis C virus infection is not cost-effective.     

深圳地区妊娠期急性脂肪肝的发病状况与母婴结局

目的了解深圳地区妊娠期急性脂肪肝(AFLP)的发病率、临床特点及母婴结局。 方法统计深圳地区2003年至2010年8年间分娩孕产妇数,收集符合诊断为妊娠期急性脂肪肝的病例,分析其发病率、临床特点及母婴结局。 结果8年间深圳地区分娩孕产妇982 761例次,符合妊娠期急性脂肪肝诊断标准的病例44例,发病率为1/22 335。44例妊娠合并急性脂肪肝患者中,合并妊娠期高血压疾病的有23例(52%);平均年龄(27.7±5.7)岁,发病孕周为30^＋2～40^＋3周,初产妇占33例(75%),多胎妊娠占9例(20%)。37例(84%)首发症状为不同程度的消化道症状,40例(91%)出现黄疸并进行性加重,39例(89%)病例出现凝血功能障碍,25例(57%)出现肾功能不全,9例(20%)合并肝性脑病,5例(11%)出现多器官功能障碍。孕产妇痊愈39例,死亡5例,孕产妇死亡率为11%;分娩胎儿55例,死胎9例,新生儿死亡1例,围生儿死亡率为18%。 结论深圳地区妊娠期急性脂肪肝以晚孕期消化道症状为首发症状,同时伴有黄疸、肝酶升高、凝血功能障碍,并出现早发肾功能不全为主要临床特点。早期诊断,及时终止妊娠可改善母婴结局。     

妊娠合并乙型肝炎病毒感染对妊娠结局的影响

目的：探讨妊娠合并乙肝病毒感染影响妊娠结局的因素。方法：采用回顾性方法分析了1989年1月至1992年12月期间183例妊娠期存在乙肝病毒感染者的妊娠结局。结果：(1)妊娠合并乙肝病毒感染各并发症的发生率：胎膜早破21．31％，早产12．02％，妊高征10．38％，胎儿窘迫12．02％，产后出血3．23％，新生儿窒息10．38％；(2)妊娠合并乙肝病毒感染有肝功能异常组与肝功能正常组相比其早产(28．17％)、妊高征(22．54％)、胎儿窘迫(25．35％)、产后出血(8．45％)发生率均明显增高，新生儿出生体重则明显降低。结论：妊娠合并乙肝病毒感染，易发生胎膜早破、早产、妊高征、胎儿窘迫及产后出血，肝功能异常对这些妊娠并发症的发生有显著影响。应重视该类病例的治疗。     

妊娠合并肝功能损害对妊娠结局的影响

目的探讨妊娠合并肝功能损害(妊娠肝损)对妊娠结局的影响.方法分析比较了80例妊娠肝损患者及同期随机抽查的56例非肝损患者(对照组)的临床资料.结果肝损组新生儿体重、分娩孕周均显著低于对照组(P＜0.05);肝损组羊水污染率明显高于对照组(P＜0.05),肝损组新生儿窒息率高于对照组,但无统计学差异;肝损组血ALT＞500nmoL@S-1/L患者与ALT＜500nmoL@S-1/L的患者相比,早产儿发生率明显增加(P＜0.05).结论妊娠肝损可影响新生儿的体重,且羊水污染机会明显增加,积极正确的处理可以使肝损患者安全度过围产期并能提高围生儿的生存质量.     

Management of viral hepatitis A,C, D and E in pregnancy

Viral hepatitis can cause significant maternal and neonatal morbidity and mortality. Hepatitis A and E mainly present as acute hepatitis during pregnancy, while hepatitis C and D are usually found as chronic infection in pregnant women. Hepatitis A remains self-limiting during pregnancy while hepatitis E has a higher prevalence and manifests with a rigorous course in pregnant women. Screening of hepatitis C during pregnancy and its subsequent management during pregnancy are still a debatable topic. New treatments of hepatitis C and E require further evaluation for use in pregnancy. This review summarizes the prevalence, clinical manifestations, maternal, foetal and neonatal effects, and the management of hepatitis A, C, D and E viral infection during pregnancy.     

Severe liver disease in pregnancy

Objective: To determine the clinical characteristics of patients with fulminant hepatitis of pregnancy (FHP) and acute fatty liver of pregnancy (AFLP) and analyze their correlation with pregnancy outcome. Methods: Of 55 pregnant women with severe liver disease, 41 had FHP and 14 had AFLP. Results: Jaundice was the primary manifestation for both FHP and AFLP and hepatic encephalopathy was the most significant complication for both. Disseminated intravascular coagulation, albuminuria, and prothrombin activity were found to be independent risk factors of maternal mortality for both. However, the rates of preterm labor, fetal demise, and neonatal asphyxia were lower in the FHP group. Conclusion: Women with FHP or AFLP are at risk for severe complications and adverse pregnancy outcome. Since the 2 conditions are managed differently, early diagnosis is essential.     

Successful surgical treatment of a primary liver gastrinoma during pregnancy: a case report

Primary neuroendocrine tumors of the liver, particularly gastrinomas, are exceptionally rare. We present a case of a sporadic primary liver gastrinoma in a young woman in whom the definitive diagnosis was reached, and surgical therapy was performed during pregnancy.     

Acute fatty liver of pregnancy

Objective Acute fatty liver of pregnancy (AFLP) is a rare and serious entity associated with significant maternal and neonatal mortality and morbidity. We describe our experience with the clinical diagnosis, management and course patients with AFLP.Study design Medical records of patients with AFLP were reviewed over a 10-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes.Results The incidence of AFLP was 1 in 7,270 births. The mean gestational age at onset was 34.6 ± 4.9 weeks. Eight percent of the patients were multiparous with more than three pregnancies. The prodromic phase was variable; patients complained of nausea, abdominal pain, malaise, polyuria-polydipsia syndrome and headaches followed by jaundice. The laboratory results indicated coagulopathy, liver function abnormalities and hypoglycemia. Emergency cesarean section was performed in two cases. The diagnosis has been assessed by transcutaneous hepatic biopsies processed in all patients between the 4th and 15th day (8.4 ± 4.3 days). Maternal morbidity included hypoglycaemia (40%), coagulopathy (50%) encephalopathy (30%) and renal failure (40%). There were no maternal deaths but fetal mortality is high 66%.Conclusion The early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved.     

妊娠合并肝衰竭的产科处理

妊娠合并肝衰竭严重影响母亲和胎婴儿健康,治疗上缺乏特效药物和手段,积极恰当的产科处理可改善患者预后、降低母亲和胎儿死亡率。临床上应以个体化治疗为原则,针对肝衰竭的病因、病情的严重程度、孕妇和胎儿情况选择终止妊娠的时机和方式,同时做好分娩期的综合处理。     

Ruptured subcapsular liver hematoma in pregnancy: a case report of nonsurgical management

Ruptured subcapsular liver hematoma in pregnancy is a rare condition that is usually managed surgically. Recently, however, surgical and obstetric literature has discussed conservative management. We describe successful conservative management of ruptured subcapsular liver hematoma in a woman with preeclampsia who had hemoperitoneum seen at cesarean section.     

Hepatitis B and pregnancy: An update review article

Chronic hepatitis B, as a global health problem, is a disease that begins in the prenatal period and its complications gradually become clear later in life. About 5% of women worldwide are carriers of chronic hepatitis B virus(HBV). The most common method of transmission of HBV around the world is from mother to infant. This article aims to review the unique challenges of hepatitis B in pregnancy. Data for this review were collected from our previous studiesand experiences plus various data banks, such as Pub Med, EMBASE, ISI Web of science, Scopus, Google Scholar and Iranian databases. A comprehensive search was performed using the combinations of the keywords to review relevant literature and higher education journals. All published data up to February 2014 have been included in this review. This article addresses several interesting aspects. First, hepatitis B in pregnancy can vary regarding prevalence, virus behavior, prenatal transmission and outcome of the pregnancy. Second, the women of reproductive age with chronic HBV remain a major source for continued spread of the virus. Finally, pregnant women need screening in prenatal care to enable early intervention when necessary.     

妊娠合并多系统器官功能的衰竭13例临床分析

目的 了解妊娠合并多系统器官功能衰竭（MSOF）发病的特点与诱因。方法 对1992年2月至1999年6月收治的13例妊娠合并MSOF的病例进行回顾性分析。结果 本组13例均存在2个或2个以上的器官或系统发生功能衰竭;诱因为感染者4例,为心脏疾病患者5例,为妊娠高血压综合征（妊高征）者3例,为羊水栓塞者1例;12例治愈,1例死亡,新生儿死亡1例。结论 在妊娠合并MSOF的治疗中,控制诱因的进一步发展,是取得治疗成功的前提,适时终止妊娠及选择正确的分娩方式至关重要。     

Pregnancy-specific liver diseases

Liver disease presenting in pregnancy may be due to a pregnancy-specific liver disorder, due to previously unrecognised pre-existing liver disease, or de novo liver disorders coincidentally presenting in a pregnant woman. The pregnancy-specific liver diseases can span from mild disease with limited impact on maternal and foetal health to severe disorders that can result in significant morbidity and mortality for mother and foetus. Swift identification of these disorders is essential to allow timely and appropriate management via a multi-disciplinary approach. The pregnancy-specific conditions, including their presentation, investigations, and management are reviewed in this chapter in detail.     

妊娠合并重症肝炎29例临床分析

目的探讨妊娠合并重症肝炎的发病情况与有关围产期正确处理方式，减少对母儿的威胁。方法对我院近8年来29例妊娠合并重症肝炎的病例进行回顾性分析，通过分析其临床表现、病毒标志物、血生化、B超、病理观察、临床处理与妊娠结局，总结对该病的诊治经验和教训。结果急性重症肝炎7例（乙型3例、乙丙重叠感染1例、乙戊重叠感染2例、戊型1例），亚急性重症肝炎11例（乙型7例、戊型1例、病毒阴性3例），慢性重症肝炎11例（乙型10例、病毒阴性1例）。孕产妇预后：治愈2例、好转13例、未愈自动出院5例、死亡9例，死亡率为31．0％。死胎1例，死产2例，新生儿死亡4例，新生儿存活率占69．2％，围产儿死亡率为43．8％。结论妊娠合并重症肝炎严重危及母婴生命安全，是产科严重的合并症之一，定期产前教育和检查及早发现和处理是关键。     

Effect of pregnancy and stage of pregnancy on asthma severity: a systematic review

Although pregnancy is purported to affect maternal asthma, the literature has not been reviewed systematically. The purpose of this systematic review was to determine, among pregnant women with asthma, whether pregnancy and stage of pregnancy influence maternal asthma severity. Six electronic databases were searched in January 2003 for prospective studies of currently asthmatic, pregnant women who were enrolled before the third trimester and assessed with objective measures of asthma severity or validated severity scales. Three studies reported 54 pregnant women with asthma who met the inclusion criteria. The most valid study indicated that bronchial hyperresponsiveness to methacholine improved between preconception and pregnancy in 69% of the women, although it deteriorated in 31% of the women. Further, this improvement peaked in the second trimester, reverted after delivery, and was greatest among those women who were most hyperresponsive initially. Lung function also showed a trend towards improvement during pregnancy that was not significant. Large, well-conducted population-based studies that explore different aspects of asthma severity are needed to substantiate these preliminary results.     

乙型肝炎病毒感染与妊娠肝内胆汁淤积症的相关性研究

目的　探讨无症状乙型肝炎病毒 (HBV)感染是否会影响妊娠肝内胆汁淤积症 (ICP)的发生率、病程及相关并发症。方法　 1997年 1月至 2 0 0 1年 7月对 76 5 1例孕妇进行乙型肝炎 (乙肝 )血清学测定 ,分析比较乙肝血清学HBV表面抗原 (HBsAg)、HBVe抗原 (HBeAg)及HBV核心抗体 (HBcAb)阳性孕妇与阴性孕妇其ICP发生、转归的相关性。结果　在有HBV感染的孕妇中其ICP的发生率明显高于无HBV感染的孕妇 (分别为 9 7%及 4 2 % ,P <0 0 0 1)。有HBV感染的孕妇发生ICP瘙痒症状的时间明显早于无HBV感染的孕妇 ,分别为( 2 8 8± 3 2 )周及 ( 32 1± 2 7)周 ,P <0 0 0 1。有HBV感染的ICP孕妇终止妊娠时间明显早于无HBV感染的ICP孕妇 ,分别为 ( 36 1± 0 9)周及 ( 37 8± 1 6 )周 ,P <0 0 0 1。在ICP组中有无HBV感染其早产发生率差异有非常显著性意义 ,分别为 2 9 5 %及 12 2 % ,P <0 0 0 1。ICP孕妇中有无HBV感染产后 2 4h内阴道出血量差异也有非常显著性意义 ,分别为 ( 335 0± 76 7)mL及 ( 2 78 0± 97 6 )mL ,P<0 0 0 1。结论　感染了HBV的孕妇其ICP的发生率增高 ,应加强对这些孕妇的孕期监护 ,并且积极防治早产及产后出血的发生。     

妊娠间隔对经产妇妊娠结局的影响多中心回顾性研究

目的:探讨不同妊娠间隔（IPI）对经产妇妊娠结局的影响。方法:基于全国14个省区市共21家医院开展多中心回顾性研究,通过查阅病历收集2011—2018年间两次妊娠均在同一家医院分娩的经产妇的年龄、身高、孕前体重、IPI、既往史、妊娠合并症和并发症、分娩孕周、分娩方式、妊娠结局等资料。根据不同IPI分为4组：<18个月组...