Esta semana se enviaran artículos relacionados con la patología médica durante el embarazo: paciente crítica, hígado, cardiopatías, hipertensión arterial, HELLP, pulmón y otros temas relevantes en la mujer con embarazo de alto riesgo. Se le invita a bajar y resguardar los artículos enviados que le interesen, ya que algunas revistas suspenden los accesos libres en el internet, lo cual hace imposible accesarlos posteriormente. La mayor parte de la información enviada se está archivando en nuestro repositorio informático, donde es posible consultarla y bajarla. |
| Obstetricia crítica |
Introducción. Las enfermedades hepáticas se presentan en menos de 0,1% de los embarazos (Schoor 1991). Entre aquellas afecciones que son específicas del mismo se encuentran: · Hígado graso agudo, · Colestasis intra-hepática, · Síndrome HELLP, Otras enfermedades agudas ajenas a la gestación podrán surgir en cualquier periodo del mismo, en ocasiones generando dificultades en el diagnóstico diferencial. Las más frecuentes son: · Hepatitis viral aguda · Intoxicaciones · Metástasis hepáticas. Según Hunt (1999), la hepatitis viral aguda es la causa mas frecuente de ictericia en el embarazo. El tercer grupo patológico está representado por embarazos en enfermas con afecciones hepáticas crónicas, como la cirrosis post-necrótica o la etílica. La cirrosis biliar primaria suele agravar su curso durante el embarazo (Hunt 1994). La enfermedad de Wilson continuará su tratamiento con penicilamina; mientras la hepatitis crónica activa autoinmune mantendrá la indicación de prednisolona y azatioprina durante la gestación (Hunt 1999, Riely 1994). Sin embargo, un avanzado estado de hepatopatía crónica se asocia con esterilidad (Sandhu 2003), dado que, con el curso de la gestación, se observa una alta proporción de abortos, partos prematuros, mortinatos y bajo peso al nacer (Schorr 1991).
http://www.obstetriciacritica.com.ar/doc/SISTEMATICA_higado.pdf
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| Hepatitis B crónica en el embarazo: oportunidades y retos. |
Chronic hepatitis B in pregnancy: unique challenges and opportunities.
Yogeswaran K, Fung SK.
Department of Medicine, University of Toronto, Toronto, Canada.
Korean J Hepatol. 2011 Mar;17(1):1-8. doi: 10.3350/kjhep.2011.17.1.1.
Abstract
Chronic hepatitis B (CHB) affects 350 million individuals worldwide. Perinatal transmission leads to high rates of chronic infection and complications, including cirrhosis and hepatocellular carcinoma. It is important to recognize and appropriately treat CHB in pregnancy, thereby reducing the risk of neonatal transmission and HBV-associated morbidity and mortality. Screening for CHB is recommended in all pregnant mothers as is universal vaccination of infants with hepatitis B virus (HBV) vaccine with or without hepatitis B immunoglobulin (HBIG). This has resulted in a lower incidence of HBsAg seropositivity and HCC in regions where universal infant vaccination has been endorsed. Mode of delivery and breastfeeding do not appear to affect HBV transmission rates based on available data. Overall, CHB does not increase perinatal maternal-fetal mortality. Administration of oral antiviral therapy during the third trimester to HBsAg-positive mothers with HBV DNA≥7 log IU/mL may be useful in preventing breakthrough infection. Treatment may be considered earlier in pregnancy for persistently active liver disease shown by high ALT, HBV DNA levels and/or significant hepatic fibrosis. Lamivudine, tenofovir and telbivudine are safe and effective and are the agents of choice in pregnancy. However, further clinical studies are necessary to elucidate the role of antiviral therapy in the pregnant HBV carrier
http://www.koreanjhepatol.org/journal/view.php?year=2011&vol=17&no=1&spage=1
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| Transmisión perinatal del virus de la hepatitis B: experiencia Australiana |
Perinatal transmission of hepatitis B virus: an Australian experience.
Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, Maley MW, Ayres A, Locarnini SA, Levy MT.
Liverpool Hospital, Sydney South West Area Health Service, Sydney, NSW, Australia.
Med J Aust. 2009 May 4;190(9):489-92.
Abstract
OBJECTIVE: To determine the rate of perinatal hepatitis B virus (HBV) transmission in an Australian setting and to identify maternal virological factors associated with highest risk of transmission. DESIGN, PARTICIPANTS AND SETTING: A prospective, observational study of perinatal transmission of HBV. Participants were pregnant women attending Sydney South West Area Health Service antenatal clinics who tested positive for hepatitis B surface antigen (HBsAg), and their babies. All babies were routinely offered hepatitis B immunoglobulin (HBIG) and HBV vaccination. Babies positive for HBsAg at 9-month follow-up underwent further virological testing, including HBV DNA sequencing. The study was conducted between August 2002 and May 2008. MAIN OUTCOME MEASURES: HBV DNA levels and demographic characteristics of HBsAg-positive pregnant women; proportion of their infants with active HBV infection at 9-month follow-up; maternal characteristics affecting transmission rate; HBV DNA sequencing of infected infants and their mothers. RESULTS: Of 313 HBsAg-positive pregnant women, 213 (68%) were HBV DNA-positive and 92 (29%) were positive for hepatitis B "e" antigen (HBeAg); 138 babies born to HBV DNA-positive mothers were tested for HBV infection (HBsAg positivity) at about 9 months of age. Four cases of transmission were identified. All four mothers had very high HBV DNA levels (> 10(8) copies/mL) and were HBeAg-positive. Three of the four infants were infected with wild-type HBV strains, with identical maternal/infant isolates. The fourth mother-infant pair had an S gene variant, HBV D144E, which has been previously reported in association with vaccine/HBIG escape. (Unfortunately, HBIG was inadvertently omitted from the immunisation schedule of this infant.) Transmission rates were 4/138 (3%) from HBV DNA-positive mothers overall, 4/61 (7%) from HBeAg-positive mothers, and 4/47 (9%) from mothers with very high HBV DNA levels. No transmission was seen in 91 babies of mothers with HBV DNA levels < 10(8) copies/mL.
CONCLUSION: In this cohort, HBV perinatal transmission was restricted to HBeAg-positive mothers with very high viral loads
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