Uzroci jetrene disfunkcije u trudnoći i njihov rizik za majku i plod

master's thesis

• Title (english): Causes of liver dysfunction in pregnancy and consequent risk for mother and fetus
• Author: Matea Stipetić
• Mentor: Lucija Virović Jukić (mentor)
• Committee member: Davor Hrabar (predsjednik povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Committee member: Lucija Virović Jukić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Bolesti jetre u trudnoći dijele se u tri skupine: bolesti jetre povezane s trudnoćom, kronične bolesti jetre u trudnoći i bolesti jetre koincidirajuće s trudnoćom. Trudnoća mijenja fiziologiju žene i na isti način može mijenjati tijek i manifestacije bolesti. Patologija jetre može negativno utjecati na ishode trudnoće, odnosno povećati morbiditet i mortalitet majke i ploda. Intrahepatička kolestaza je češća bolest jetre povezana s trudnoćom koja može izazvati vrlo neugodan svrbež u majke, a posljedice za plod potencijalno su puno ozbiljnije i uključuju mekonijsku plodnu vodu s aspiracijom, intrauterinu smrt i prijevremeni porod. Ursodeoksikolna kiselina i indukcija poroda do 37. tjedna gestacije zlatni su standard liječenja. Akutna masna jetra u trudnoći najrjeđa je bolest u ovoj kategoriji, a može dovesti do zatajenja jetre ukoliko se ne prepozna i ne liječi na vrijeme. Jedino etiološko liječenje jest indukcija poroda, neovisno o gestacijskoj dobi djeteta. Još jedna od bolesti jetre vezanih uz trudnoću jest preeklampsija koja se definira prisutnošću novonastale hipertenzije nakon 20. tjedna gestacije uz proteinuriju i/ili oštećenje različitih organskih sustava. Preeklamptičkom ozljedom tako može biti zahvaćena i jetra. Progresijom preeklampsije nastaje eklampsija, koju karakterizira pojava kloničko-toničkih napadaja bez drugog uzroka. HELLP sindrom također se može smatrati komplikacijom preeklampsije te u kliničkoj slici uglavnom obuhvaća hipertenziju i proteinuriju. Glavne manifestacije ovog sindroma su hemoliza, povišene razine jetrenih enzima i trombocitopenija. Najučinkovitija terapijska opcija jest porod. Iako se ove bolesti pojavljuju u trudnoći, sve navedene osim intrahepatičke kolestaze mogu se pojaviti i postpartalno te ih treba imati na umu kod pogoršanja općeg stanja u rodilje. Ovakvim trudnoćama i trudnicama potrebna je multidisciplinarna skrb kako bi ishodi bili najbolji u datim okolnostima, i za majku i za plod.

Abstract (english)

Liver dysfunction in pregnancy can be related to one of the three categories of diseases: pregnancy-related liver diseases, chronic liver diseases during pregnancy, and liver diseases coinciding with pregnancy. Pregnancy changes a woman's physiology and can similarly alter the course and manifestations of disease. Liver pathology can negatively affect pregnancy outcomes, increasing maternal and fetal morbidity and mortality. Intrahepatic cholestasis is among common pregnancy-related liver diseases that can cause very uncomfortable itching in mothers and potentially much more serious consequences for the fetus, including meconium-stained amniotic fluid with aspiration, intrauterine death, and premature birth. Ursodeoxycholic acid and induction of labor up to 37 weeks of gestation are the gold standard of treatment. Acute fatty liver in pregnancy is the rarest disease in this category and can be complicated by liver failure if not recognised and treated in time. The only etiological treatment is induction of labor, regardless of the child's gestational age. Preeclampsia is defined by the presence of newly developed hypertension after the 20th week of gestation with proteinuria and damage to various organ systems. Preeclamptic injury can also affect the liver. Progression of preeclampsia leads to eclampsia, which is characterized by new-onset clonic-tonic seizures with no any other apparent cause. The HELLP syndrome can also be considered a complication of preeclampsia and its clinical picture usually includes hypertension and proteinuria. The main manifestations of this syndrome are hemolysis, elevated liver enzymes, and thrombocytopenia. The most effective therapeutic option for this condition is delivery. Although these diseases occur during pregnancy, all except intrahepatic cholestasis can also occur postpartum and should be considered when there is a worsening of the mother's general condition. These pregnancies are usually managed by a multidisciplinary approach in order to achieve the best outcomes in given circumstances, for both the mother and the fetus.

• Keywords: jetrena disfunkcija; intrahepatička kolestaza; akutna masna jetra; preeklampsija; HELLP sindrom
• Keywords (english): liver dysfunction; intrahepatic cholestasis; acute fatty liver of pregnancy; preeclampsia; HELLP syndrome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:069440
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-31 09:32:37