Acute fatty liver of pregnancy:

-AFLP is a rare condition -unknown etiology -(although fetal long-chain hydroxyacyl co-enzyme A dehydrogenase (LCHAD) deficiency).

- It has an incidence in various studies of between 1 in 7000 and 1 in pregnancies. - It is frequently fatal for the mother and baby unless there is a speedy diagnosis and the correct treatment is given.

Clinical manifestation : - an obese woman will present with vomiting and a headache in her third trimester. - She will quickly complain of malaise and severe abdominal pain, followed by jaundice and drowsiness. -50% of these women have symptoms of pre-eclampsia (hypertension and proteinuria),

-the pre-eclampsia will mask the presentation of AFLP. liver is tender but not enlarged diagnosis: -an ultrasound -computerized tomography (CT) scan of the liver demonstrates fatty infiltration. -Liver biopsy is contraindicated owing to the risk of coagulopathy. -The liver enzymes are moderately raised and the woman will also quickly show -renal failure (liver function test ) -blood glucose level (hypoglycemic.)

Management : -correcting any coagulopathy : infusing fresh frozen plasma. - The woman must be delivered immediately. -Caesarean section is said to have many advantages for the baby, but it is safest for the mother to birth vaginally if this is possible. - Epidural analgesia is contraindicated in all. -Convalescence is prolonged but usually complete. -recurrence rate is low.

Gall bladder disease -Pregnancy appears to increase the likelihood of gallstone formation but not the risk of developing acute cholecystitis. Diagnosis of gall bladder disease is made by : 1-listening to the woman's previous history 2- an ultrasound scan of the hepatobiliary tract or both.

- treatment of the biliary colic by:

* analgesia, hydration, nasogastric suction(compression ) and antibiotics. Surgery should be avoided if at all possible.

Viral hepatitis: Viral hepatitis is the most common cause of jaundice in pregnancy. - Acute infection 1 in 1000 pregnancies - an incubation period of 1–6 months.

Symptoms include : -nausea - Vomiting - anorexia - pain over the liver - mild diarrhea -jaundice lasting several weeks -malaise. - Fever is rare. - the disease is asymptomatic, or mimics mild influenza

Method of transmission : -blood, blood products. - sexual activity. - The virus can also be transmitted across the placenta.

-Hepatitis B : -is more common in tropical and developing countries. -poor nutrition. - limited use of contraception barrier) -injecting drug users who share needles -The more common infections are known as hepatitis A, B,C,D and E

**Hepatitis A (HAV): -acute infection -transmitted by ingesting water contaminated. - It is endemic worldwide. - Mother to baby transmission is rare but can occur at birth. - HAV is a self-limiting illness results in complete recovery. -Vaccination is available. - Strict hygiene -hand washing,reduces the risk of cross infection

Hepatitis B (HBV) : -serious infection. - 5–10% of those infected become chronic carriers. - 25–30% of these will die –5% of the population are chronic HBV carriers.

- test for the HBV surface antigen (HBsAg). - adults 90% cases of HBV resolve completely within 1–3 months.

-complications of HBV: transplacental passage of the virus and through blood and body fluids at birth. 1-increased risk of chronic liver disease. 2-cirrhosis 3-primary liver cancer in later life. -Caesarean section does not prevent mother to fetus transmission.

Diagnosis : history of her symptoms and lifestyle. Serological studies, but it can be difficult to distinguish hepatitis B from other forms of viral hepatitis during the acute presentation, before antibodies have formed

Treatment : Symptoms Infection control measures,the woman is considered to be infectious. Education about the disease, nutrition and sexual advice, should be offered. -Liver function will be monitored

Assess fetal condition. Household contacts should be offered immunization after their HBsAg was done. -Sexual partners should testing and giving vaccination. Postnatally the mother will be encouraged to accept vaccination for the baby. Breastfeeding is permitted

Hepatitis C virus (HCV) : risk factors for transmission are blood and blood products. the use of shared intravenous needles. post-blood transfusion hepatitis

HCV commonly from a blood donorHCV commonly from a blood donor who had yet to sero-convert at the time of blood donation who had yet to sero-convert at the time of blood donation incubation period of 30–60 daysincubation period of 30–60 days 75% asymptomatic. In the remaining.75% asymptomatic. In the remaining. 25% symptoms include transient nausea and jaundice25% symptoms include transient nausea and jaundice

Complications ; chronic HCV which is associated with B cell lymphomas. chronic liver disease. (vertical) transmission from pregnant women and placental the baby. Type of birth normal. breastfeeding safe. No vaccine is available yet

Pregnancy and liver transplantation:

–-liver transplantation done before or during pregnancy, many with successful outcomes. –-Although not desirable. –- liver transplantation in women of childbearing age is becoming possible -women require expert medical and midwifery care at a specialized centre

Ready to deal with all of the complications, both of a physical and psychological nature

Thank you