妊娠合并肝病分娩方式的探讨

The study of the delivery pattern in pregnancy associated with hepatitis

目的 了解妊娠合并轻度、重度、重症肝炎以及妊娠急性脂肪肝等肝病的分娩方式。方法 比较 1 4例妊娠合并轻度肝炎、6例妊娠合并重度肝炎、4例妊娠合并重症肝炎以及 8例妊娠合并急性脂肪肝患者的分娩方式、产程时间、终止妊娠时间、产时出血、孕产妇预后等。结果 除 4例因产科适应证而剖宫产外 ,轻度和重度肝炎组可达妊娠晚期并自然临产 ,无孕产妇和围产儿死亡 ,但重度肝炎患者普遍产程较快 ,产后出血量也较多。重症肝炎 4例中产妇死亡 2例 ,其中阴道分娩死亡 1例 ,剖宫产 2例死亡 1例。AFL P8例死亡 4例 ,其中阴道分娩 3例死亡 2例 ,剖宫产 2例死亡 1例 ,剖宫产 +子宫切除 3例死亡 1例。结论 分娩方式可根据肝损害程度进行选择 ,重症患者手术终止妊娠为有效的救治手段。病情轻者多数能阴道分娩。

Objective To study the delivery pattern in pregnancy associated with slight, severe hepatitis and acute fatty liver of pregnancy.Methods We compared the pattern of delivery, the time of labor stage, the time of terminating pregnancy, intrapartum hemorrhage, prognosis in 14 pregnancy associated with slight hepatitis, 6 pregnancy associated with less severe hepatitis, 4 pregnancy associated with severe hepatitis, 8 pregnancy associated with acute fatty liver of pregnancy. Results Except 4 taking cesarean for obstetrics reasons, these women who associated with slight, severe hepatitis might conceive until they delivered naturally. No puerperas and neonates were dead in these two groups. But the stages of labor were very short and the volume of postpartum hemorrhage was more for pregnancy associated with less severe hepatitis. Of 4 pregnancy associated with severe hepatitis two were dead, one after cesarean, the other after vaginal delivery. Of 8 acute fatty liver of pregnancy four were dead, two in three were dead after vaginal delivery, one in two was dead after cesarean, one in three was dead after cesarean and uterus cutting. Conclusions The pattern of delivery can be selected by the stage of liver lesioned. Taking operation to terminate pregnancy is an effective therapy means. Patients associated with slight, severe hepatitis can delivery through vaginal, while for severe hepatitis patients we should terminate pregnancy as soon as we can.