Liver cirrhosis during pregnancy

　　Liver cirrhosis during pregnancy refers to liver cirrhosis that occurs during pregnancy. The common causes of liver cirrhosis include viral hepatitis, chronic alcoholism, schistosomiasis, drug intoxication or chemical toxins, biliary stasis, and hereditary metabolic defects. In Western countries, alcohol intoxication is the main cause, accounting for about 65%. Compared with men, women are more prone to alcoholic liver cirrhosis, and the minimum daily alcohol intake needed to cause irreversible liver cirrhosis in women is less, and the duration is shorter. In China, viral hepatitis is the main cause of liver cirrhosis, and the relationship between hepatitis B, C, and D viruses and liver cirrhosis is close.

　　Complications of pregnant women with liver cirrhosis include anemia, pregnancy-induced hypertension, postpartum hemorrhage, and postpartum infection. The incidence of complications in pregnant women with liver cirrhosis reported abroad is as high as 40% or more. Due to the metabolism of the renin-angiotensin-aldosterone system through the liver, the activity of this system increases during liver cirrhosis, and the incidence of pregnancy-induced hypertension increases due to factors such as anemia and hypoproteinemia. Due to the lack of coagulation factors and uterine atony in patients with liver cirrhosis, the incidence of postpartum hemorrhage increases. The decreased resistance of patients with liver cirrhosis, as well as factors such as hypoproteinemia, anemia, and fatigue during labor, increase the incidence of postpartum infection.

　　The manifestations of liver cirrhosis vary with the stage of the disease. The specific introduction is as follows:

　　1. Compensation period of liver function

　　The symptoms of the patient in this period are relatively mild, which may include fatigue, decreased appetite, abdominal distension and discomfort. These symptoms often appear during fatigue and are relieved after rest. Physical signs are not obvious, and the liver is often enlarged. Some patients have splenomegaly, and spider veins and palmar erythema may occur.

　　2, Liver dysfunction compensation period

　　Loss of appetite is a common symptom in this period, sometimes accompanied by nausea, vomiting, weight loss, fatigue, upper abdominal pain or bloating, gum or nosebleeds, and may appear hematemesis and melena. Physical examination may reveal dark complexion, emaciation, purple spots or bleeding points on the skin and mucous membranes, dilated abdominal wall veins, ascites, moderate hardness of the liver, etc. In the late stage, the liver may shrink, become hard, present nodules on the surface, and may appear splenomegaly.

　　The prevention of pregnancy complicated by liver cirrhosis focuses on etiological prevention, that is, the prevention of viral hepatitis, chronic alcoholism, schistosomiasis, drug poisoning, or chemical toxic biliary stasis, genetic metabolic defects. Do not lie flat immediately after meals to avoid reflux of stomach contents. Food should not be rough, and tablets should be crushed. Try to avoid coughing, holding breath, etc. Pay attention to rest and nutrition during the postpartum period, follow up on liver function, and do not breastfeed.

　　The examination for pregnancy complicated by liver cirrhosis is the same as that for liver cirrhosis, generally including blood biochemistry, ultrasound examination, etc. For some cases, liver biopsy may be helpful for diagnosis if necessary. At the same time, routine examination methods for this disease also include blood routine, X-ray, CT examination, etc., which can be selected according to the situation.

　　There are no special dietary requirements for patients with pregnancy complicated by liver cirrhosis, generally normal diet is sufficient. Pay attention to a rich diet and balanced nutrition. Ensure the needs of the human body for normal metabolism, including calories, proteins, and vitamins. In terms of health care, pay attention to relaxing the mind, building confidence, maintaining a good attitude, and actively cooperating with the doctor's treatment.

　　Whether patients with pregnancy complicated by liver cirrhosis should continue pregnancy needs to be determined according to the specific situation. Pregnant women with liver dysfunction, prolonged prothrombin time, or esophageal varices should terminate pregnancy as early as possible. If there are only esophageal varices and the patient urgently hopes to become pregnant, the patient should undergo portocaval shunt surgery before pregnancy, and most can deliver smoothly.

　　For patients who have terminated pregnancy and undergone surgery, the surgeon should be someone with skilled operation and experience to minimize bleeding and shorten the operation time as much as possible. Pay attention to rest and nutrition during the postpartum period, follow up on liver function, and do not breastfeed.