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Gastroenterologie up2date 2022; 18(02): 115-133
DOI: 10.1055/a-1543-1661
Leber/Galle/Pankreas

Hepatologische Erkrankungen in der Schwangerschaft

Lars Brodowski
,
Vincent Zimmer
,
Constantin von Kaisenberg
,
Peter Hillemanns
,
Frank Lammert
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Lebererkrankungen komplizieren etwa 5% aller Schwangerschaften. Da neben maternalen insbesondere fetale Komplikationen auftreten können, erfordern diese eine kompetente hepatologische Betreuung in enger interdisziplinärer Kooperation mit dem Geburtshelfer. Der Artikel stellt die schwangerschaftsspezifischen Lebererkrankungen, die klinisch relevanten Aspekte koinzidenter und präexistenter Lebererkrankungen sowie die Besonderheiten im Rahmen der Schwangerschaft zusammen.
Kernaussagen

  • Bei epigastrischen Schmerzen, Übelkeit, Erbrechen oder Pruritus ohne Exanthem in der Schwangerschaft kann eine spezifische Lebererkrankung vorliegen.

  • Bei rechtsseitigen Oberbauchschmerzen sollte in der Schwangerschaft an ein HELLP-Syndrom (Hemolysis – elevated Liver Enzymes – low Platelets) gedacht und eine unverzügliche laborchemische Abklärung durchgeführt werden. Eine nicht diagnostizierte Lebererkrankung kann für Mutter und Kind fatale Konsequenzen haben.

  • Im Rahmen einer Präeklampsie kommt es bei 20% der Patientinnen zu einer Leberbeteiligung, die einen schwerwiegenden Präeklampsieverlauf mit erhöhter perinataler Morbidität und Mortalität anzeigt.

  • Lebererkrankungen in der Schwangerschaft können Indikatoren anderer Leber-, Gallenwegs- und Stoffwechselerkrankungen sein (Beispiele: intrahepatische Schwangerschaftscholestase [ICP], akute Schwangerschaftsfettleber [AFLP]).

  • Bei HBsAg-positiven Schwangeren mit einer Viruslast > 106 Kopien/ml (> 200 000 IU/ml) sollte zwischen SSW 24 und 28 eine antivirale Therapie mit Tenofovir zur Transmissionsprophylaxe eingeleitet werden.

Schlüsselwörter

Eklampsie - HELLP-Syndrom - Nukleotidanalogon - Schwangerschaftscholestase - Schwangerschaftsfettleber - Ursodeoxycholsäure - Virushepatitis


Publication History

Article published online:
01 July 2022

© 2022. Thieme. All rights reserved.

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