妊娠合并病毒性肝炎诊治进展

Progress in treatment of viral hepatitis during pregnancy

病毒性肝炎是我国最常见的妊娠合并症之一,尤以乙肝为常见。孕前应检测肝功能和病毒负荷,选择肝功能正常和病毒负荷低时计划妊娠;孕期应动态观察肝功能变化,及时评估和处理,病情发展到重型肝炎前进行处理预后良好;妊娠合并重型肝炎死亡率高,在积极内科治疗基础上,选择恰当时机行剖宫产加子宫次全切除有可能改善预后;在母婴传播方面,妊娠合并乙肝研究较多,孕期使用乙肝免疫球蛋白(HB IG)、乙肝疫苗和拉米夫定等进行阻断乙肝母婴传播的有效性和安全性还有待进一步研究;分娩方式以产科指征为主,产后使用乙肝疫苗和HB IG联合免疫可有效阻断母婴传播,母乳检测病毒阴性者可考虑母乳喂养。

Viral hepatitis especially hepatitis B is the most common complication of pregnancy in our country.Liver function and load of virus must be checked before pregnancy and the time when the liver function is normal and the load of virus is low is the opportunity for planning to get pregnant.Liver function must be observed dynamically and the disease should be assessed and treated in time.Good prognosis could be obtained if the treatment be delivered before developing into hepatitis gravis.The mortality rate of...