Acute fatty hepatosis of pregnant women (Sheehan syndrome)

A woman s liver can be damaged during pregnancy or damage can be accompanied by pregnancy. The liver diseases caused by pregnancy are- acute liver hepatosis, HELLP syndrome, and intrahepatic cholestasis. Acute liver hepatosis- is usually revealed in the last trimester of the pregnancy. There are a lot of theories about its development. The main of them are thrombosis of the liver vessels, endothelial dysfunction, immunologic conflict between mother and fetus as it develops in the definite period. What happens to the liver in this syndrome? During biopsy it is revealed that no tissue necrosis and inflammation happens, only fatty infiltration happens. And it differs this syndrome from the others happening during pregnancy. But because of clotting system failure in the Sheehan syndrome liver biopsy is not acceptable. Putting diagnosis with other instrumental methods as US and MRI is difficult but possible. The Sheehan syndrome has 3 periods 1st period- symptoms are manifested between 30-34 weeks of pregnancy-they are nausea, vomitus, stomach pain, pain on the right upper side of abdomen, heartburn, itching which strengthens as the disease develops. The 2nd period- begins with icterus and increases on the disease development. The 3rd period-liver insufficiency. And specific to this disease is absence of encephalopathy in this period. Blood analysis during this syndrome is elevation of liver enzymes-(2-3 times), alkaline phosphatase, ALAT, ASAT, decrease of clotting factors produced by the liver, bilirubin increase (conjugated and unconjugated). The main risk of this is that in such heavy conditions fetus cannot survive ,it causes disseminated intravascular clotting syndrome which is characterized with massive bleeding. Incidence of the disease is 1, 2% between pregnant women. The obstetricians goal is in time revealing of the disease. Treatment is delivery (stimulated delivery or operative delivery due to the present state). If operative delivery is going to be held fresh freeze plasma must be infused. Until the condition of the woman recently confined improves vitamins and hepatoprotectors must be infused.


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