Hepatitis in pregnancy

Acute herpes hepatitis in pregnancy. J. Clin. Pathol. 1993 46 968—971... 

Klein, N.A., Mabie, W.C., Shaver, D.C., Latham, P.S., Adamec, T.A., Pinstein, M.L., Riely, C.A. Herpes simplex virus hepatitis in pregnancy. Two patients successfully treated with acyclovir. Gastroenterology 1991 100 239 - 244... 

Picaud A, Walter P, de Preville G, Nicolas P. Hepatite toxique morteUe au cours de la grossesse. [Fatal toxic hepatitis in pregnancy. A discussion of the role of methyldopa.] J Gynecol Obstet Biol Reprod (Paris) 1990 19(2) 192-6. 

Khuroo M, Kamili S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J Viral Hepat 2003 20 61-9. 

Liver Two independent case reports have described acute hepatitis in pregnancy related to methyldopa [98, 99 ]. Each presented with jaundice and dark urine one in the first trimester and one in the second trimester. In both cases the hepatitis resolved quickly, although in one case prednisolone was given. 

The nurse should use cephalosporins cautiously in patients with renal or hepatic impairment and in patients with bleeding disorders. Safety of cephalosporin administration has not been established in pregnancy or lactation these drugs are assigned to Pregnancy Category B. 

Methotrexate, an antimetabolite, is indicated for moderate to severe psoriasis. It is particularly beneficial for psoriatic arthritis. It is also indicated for patients refractory to topical or UV therapy. Methotrexate can be administered orally, subcutaneously, or intramuscularly. The starting dose is 7.5 to 15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk. Adverse effects include nausea, vomiting, mucosal ulceration, stomatitis, malaise, headache, macrocytic anemia, and hepatic and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by giving oral folic acid 1 to 5 mg/day. Methotrexate should be avoided in patients with active infections and in those with liver disease. It is contraindicated in pregnancy because it is teratogenic. 

Hepatic function impairment Do not use ramelteon in patients with severe hepatic function impairment. Use with caution in patients with moderate hepatic function. Pregnancy Category C. 

Hepatic function impairment Doses more than 2 g/day IV can be extremely dangerous. In the presence of renal dysfunction, and particularly in pregnancy, IV tetracycline more than 2 g/day has been associated with death secondary to liver failure. Hepatotoxicity has been reported with minocycline. Administer with caution reduce the recommended dosage and/or extend the dosing interval. 

Telithromycin is principally excreted via the liver and kidney. Telithromycin may be administered without dosage adjustment in the presence of hepatic impairment. Pregnancy Category C. 

Baseline tests CBC, hepatic function, pregnancy test, TSH, renal function, uric acid, HCVRNA level. Exclusions to treatment platelet count <90,000 cells/mm (as low as 75,000 cells/mm in patients with cirrhosis) absolute neutrophil count < 1,500 cells/mm serum creatinine concentration > 1.5 X upperlimit of normal abnormal thyroid function... 

Contraindications to interferon alfa therapy include hepatic decompensation, autoimmune disease, and history of cardiac arrhythmia. Caution is advised in the setting of psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, and cytopenia. Alfa interferons are abortifacient in primates and should not be administered in pregnancy. Potential drug-drug interactions include increased theophylline levels and increased methadone levels. Co-administration with didanosine is not recommended because of a risk of hepatic failure, and co-administration with zidovudine may exacerbate cytopenias. 

Experience with thiabendazole is limited in children weighing less than 15 kg. The drug should not be used in pregnancy or in the presence of hepatic or renal disease... 

Estrogens should be avoided in individuals with current thrombophlebitis or thromboembolism, estrogen-depen-dent tumors, abnormal genital bleeding without a diagnosis, and pregnancy. They are also contraindicated in apparently healthy women if they have an earlier history of jaundice in pregnancy, hepatic disease, thromboembolism, or porphyria. 

Adverse effects Colchicine treatment may cause nausea, vomiting, abdominal pain, and diarrhea (Figure 39.15). Chronic administration may lead to myopathy, agranulocytosis, aplastic anemia, and alopecia. The drug should not be used in pregnancy, and should be used with caution in patients with hepatic, renal or cardiovascular disease. 

Allergic disorders, renal, hepatic and cardiac impairment, the elderly avoid use in pregnancy, lactation, coagulation defects... 

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

Nevirapine is used in combination with at least two other antiretroviral drugs, usually for progressive or advanced HIV infection, although it appears effective also in pregnancy. It penetrates the CSF weU, and undergoes hepatic metabolism (t) 28 h). It is taken once daily, increasing to twice daily if rash is not seen. Rash and hepatitis are the commonest side effects. 

Confluent liver cell necrosis, possibly developing into bridging necroses (32) or multilobular (< 3% of cases) or even massive necroses in B, B/D and C hepatitis, as well as in E hepatitis during pregnancy collapse of the lattice fibre network. Formation of passive septa, cholestasis, accumulation of ceroid and siderin in macrophages and stellate cells. 

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