关键词： ABCB4, ATP-binding cassette subfamily B member 4 AFLP, Acute fatty liver of pregnancy ALF, Acute liver failure ALP, Alkaline phosphatase ALT, Alanine transferase ART, Antiretroviral therapy AST, Aspartate aminotransferase BCS, Budd-Chiari syndrome CT, Computerized tomography DIC, Disseminated intravascular coagulation DNA, Deoxyribonucleic acid DPTA, Diethylenetriamine pentaacetic acid ERCP, Endoscopic retrograde cholangiopancreatography FDA, Food and Drug Administration FOGSI, Federation of Obstetric and Gynaecological Societies of India GGT, Gamma-glutamyl transpeptidase GI, Gastrointestinal GRADE, Grading of Recommendations Assessment Development and Evaluation HBIG, Hepatitis B immune globulin HBV, Hepatitis B virus HBeAg, Hepatitis B envelope antigen HBsAg, Hepatitis B surface antigen HCV, Hepatitis C virus HELLP syndrome HELLP, Hemolysis, elevated liver enzymes, low platelet count HG, Hyperemesis gravidarum HIV, Human immunodeficiency virus HV, Hepatic vein ICP, Intrahepatic cholestasis of pregnancy INASL, Indian National Association for the Study of Liver IVF, In vitro fertilization LFT, Liver function test MDR, Multidrug resistance MRI, Magnetic resonance imaging MTCT, Mother-to-child transmission NA, Nucleos(t)ide analog PIH, Pregnancy-induced hypertension PT, Prothrombin time PUQE, Pregnancy-Unique Quantification of Emesis PegIFN, Pegylated interferon RNA, Ribonucleic acid TAF, Tenofovir alafenamide TDF, Tenofovir disoproxil fumarate TIPS, Transjugular intrahepatic portosystemic shunt UDCA, Ursodeoxycholic acid UGI, Upper gastrointestinal ULN, Upper limit of normal acute fatty liver of pregnancy hyperemesis gravidarum intrahepatic cholestasis of pregnancy liver diseases in pregnancy

来  源：   DOI：10.1016/j.jceh.2019.02.007   PDF(Sci-hub)   PDF(Pubmed)

Abstract：
Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to pregnancy, those coincidental with pregnancy, and preexisting liver diseases exacerbated by pregnancy. A rapid differential diagnosis between liver diseases related or unrelated to pregnancy is required so that specialist and urgent management of these conditions can be carried out. Specific Indian guidelines for the management of these patients are lacking. The Indian National Association for the Study of the Liver (INASL) in association with the Federation of Obstetric and Gynaecological Societies of India (FOGSI) had set up a taskforce for development of consensus guidelines for management of patients with liver diseases during pregnancy, relevant to India. For development of these guidelines, a two-day roundtable meeting was held on 26-27 May 2018 in New Delhi, to discuss, debate, and finalize the consensus statements. Only those statements that were unanimously approved by most members of the taskforce were accepted. The primary objective of this review is to present the consensus statements approved jointly by the INASL and FOGSI for diagnosing and managing pregnant women with liver diseases. This article provides an overview of liver diseases occurring in pregnancy, an update on the key mechanisms involved in its pathogenesis, and the recommended treatment options.
摘要：
怀孕期间发生的肝脏疾病可能很严重，进展迅速，影响母亲和胎儿的结局。它们是产科医生关注的常见原因，也是转诊给肝病医生的重要原因，胃肠病学家,或医生。怀孕期间的肝脏疾病可以分为妊娠特有的疾病，那些与怀孕巧合的人，和先前存在的肝脏疾病因怀孕而加剧。需要与妊娠相关或无关的肝脏疾病之间的快速鉴别诊断，以便可以对这些疾病进行专科和紧急处理。缺乏专门的印度指南来管理这些患者。印度全国肝脏研究协会（INASL）与印度妇产科协会联合会（FOGSI）联合成立了一个工作组，以制定妊娠期肝病患者管理的共识指南，与印度有关。为了制定这些准则，为期两天的圆桌会议于2018年5月26日至27日在新德里举行，讨论,辩论,并最终确定共识声明。只有工作组大多数成员一致批准的声明才被接受。本综述的主要目的是提出INASL和FOGSI联合批准的诊断和管理肝病孕妇的共识声明。本文概述了妊娠期发生的肝脏疾病，关于其发病机制的关键机制的更新，以及推荐的治疗方案。
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