肝移植术后妊娠

Pregnancy after Liver Transplantation

目的探讨肝移植术后妊娠的指征,母体和胎儿/新生儿存在的风险及其处理措施。方法复习相关文献并进行综述。结果肝移植术后多数育龄妇女可以恢复正常月经周期。高血压、肾功能损害、先兆子痫、继发于免疫抑制的细菌和病毒感染以及剖宫产几率增加是母体的主要风险。胎儿/新生儿的风险主要是流产、早产、胎膜早破、肾上腺皮质功能不足、胎儿畸形、免疫缺陷和巨细胞病毒、乙肝病毒及细菌感染。结论在多数患者,肝移植术后妊娠可以获得良好效果,但在妊娠前应进行严格的评估,在妊娠期应多科联合进行严密的监测。当前应制定一个基于现有研究结果的肝移植术后妊娠指南。

Objective To investigate the indications, maternal and fetal/neonatal risks and treatments of pregnancy after liver transplantation. Methods The related published literatures were summarized and reviewed. Results Most females can recover a regular menstrual cycle. Hypertension, preeclampsia, bacterial and viral infection resulted from immuno-suppression therapy and increasing rate of caesarian section are the major risks for the mother. Abortion and pre-term delivery, premature rupture of fetal membrane, hypoadrenalism, abnormality, immune deficiency, hepatitis virus B and cytomegalovirus and bacterial infection are the major risks for the fetus/neonate. Conclusion Satisfactory results can be obtained in most pregnancies after liver transplantation. Evaluation before gestation and surveillance during gestation by the related departments are mandatory. A guideline based on large cases is necessary for pregnancy after liver transplantation.