Intra-hepatic cholestasis of pregnancy in hepatitis C virus infection

BACKGROUND: Aims of this study were to investigate whether hepatitis C virus infection influences the incidence and natural history of intrahepatic cholestasis of pregnancy (ICP) and whether ICP has different characteristics in hepatitis C virus (HCV) positive women from ICP in HCV negative women. METHODS: A prospective study for the prevalence of the HCV infection and for the incidence of ICP was carried out in the 5840 patients admitted to the Prenatal Department of Padua University, Italy, between January 1996 and January 1999. Testing was done for HCV by the enzyme linked immunosorbent assay (ELISA 3), recombinant immuno blot assay (RIBA 3) and polymerase chain reaction (PCR). The diagnosis of ICP was made on clinical grounds based on the occurence of pruritus with onset during pregnancy, persisting up to the time of delivery and disappearing after delivery, supported by demonstrating an elevation of both serum ALT and total serum bile acids. The Student's t-test, one way anova and chi-square tests were used for statistical analysis. RESULTS: During the study period, 56 of 5840 patients developed ICP (0.96%). Of these, 12 were also HCV-RNA positive. The rate of ICP was observed more commonly in HCV-RNA positive women than in HCV-RNA negative women (20.33% or 12/59 versus 0.78% or 44/5767, P = 0.001 CONCLUSIONS: Occurrence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Although the diagnosis of ICP is not confirmed by specific tests, we confirmed a higher risk of HCV infection in this condition. Therefore, occurence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Broader studies are necessary to assess the impact of infection on the perinatal outcome of ICP.     

The bromsulphalein test for liver function in toxemias of pregnancy

The findings in the tables may be summarized as follows: Of 20 normally pregnant women in the last month of pregnancy, there were 3 whose serum showed a trace of bromsulphalein forty-five minutes after its injection. Of the seven women in the first or second trimester with exaggerated vomiting, two showed marked retention of the dye, the others none. One with retention left the service against advice and died four weeks later in another hospital, the other developed acute jaundice and recovered after termination of the pregnancy. In the group composed of 13 women with hypertension, albuminuria and edema unassociated with convulsions, the retention of the dye was in no instance greater than 5 per cent. However, in these patients the clinical picture, in spite of the absence of liver dysfunction, was grave. In 9, sclerotic or albuminuric retinal changes were present, and in the majority pregnancy was artificially terminated. In the last group where pregnancy was associated in the last trimester with toxemia and convulsions, 5 showed not more than a trace of retention. Three in whom the retention was 15 per cent died, one from postpartum infection, and the others from the toxemia antepartum. In contrast the patient, who of the entire group showed the highest percentage of retention, 20 per cent, recovered following the induction of labor.     

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。     

Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy

BACKGROUND: Reports of obstetric complications of mothers infected with hepatitis C virus (HCV) are limited and the risk of mother-to-infant transmission varies widely. We assessed the course of pregnancy in HCV-infected women and the rate of vertical transmission. METHODS: Between October 1992 and December 1996, 3712 pregnant patients of the university hospital Grosshadern Munich, Germany, were screened for anti-HCV and analyzed for HCV-RNA by polymerase chain reaction. Clinical and biochemical parameters were monitored. Children born to HCV-positive women were followed up at 6, 12 and 18 month intervals and screened for anti-HCV and HCV-RNA. RESULTS: Thirteen (42%) of 31 anti-HCV positive patients had a cesarean section which was twice the rate of that in the HCV-negative group (p=0.004). None of the cesarean deliveries was due to complications directly caused by HCV infection. Nine (29%) of 31 anti-HCV positive women had preterm delivery compared to 19% in the anti-HCV negative patients, the difference being statistically not significant. Fetal outcome parameters such as APGAR score, umbilical pH and birth weight of HCV infected pregnancies were not impaired. All 29 babies tested for anti-HCV were seropositive after birth. Between 12 and 18 months of age, 10% of the infants still were anti-HCV positive, whereas only one baby was HCV-RNA positive beyond 12 months yielding a vertical transmission rate of 5% among HCV-RNA positive mothers. CONCLUSION: Anti-HCV positive pregnancies have an increased risk of cesarean delivery, probably due to the high-risk collective of anti-HCV positive mothers. The mother-to-child transmission rate is low and linked to maternal HCV-RNA positivity.     

妊娠合并乙型肝炎病毒感染孕妇胎儿窘迫发病原因分析

目的：探讨妊娠合并乙型肝炎病毒（HBV）感染孕妇胎儿窘迫的病因、预后及治疗方法。方法：对81例妊娠期HBV表面抗原（HBsAg）、HBVe抗原（HBeAg)、HBV核心抗体（HBcAb)和HBV DNA均阳性,肝功能正常的孕妇及其新生儿（研究组）,85例无肝炎病毒感染,肝功能正常的孕妇及新生儿（对照组）的临床资料、血清学检查结果、胎盘病理检查结果和胎儿预后进行分析,并对研究组中76例婴儿在出生后0、1、6月龄时分别注射酵母菌重组乙型肝炎疫苗10μg,24月龄时检测婴儿HBV表面抗体（HBsAb),以评价母婴HBV阻断效果。结果：（1）研究组胎儿窘迫的发生率为38．3％,对照组为16．5％,两组比较差异有显著性（P＜0．05）。（2）HBV感染胎盘可导致绒毛膜血管病。（3胎儿窘迫者,24月龄时母婴阻断率为78．6％,无胎儿窘迫者母婴HBV阻断率为91．7％,两 者比较,差异有显著性（P＜0．05）。结论：妊娠合并HBV感染,可引起胎盘绒毛膜血管病,致使胎盘功能下降,临床表现为胎儿窘迫、进而导致HBV母婴阻断失败。