Obstetrical and gynecologic challenges in the liver transplant patient
| Autor: | Muhammad Hashim Hayat, Ioannis A. Ziogas, Georgios Tsoulfas |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population 030232 urology & nephrology 030230 surgery Liver transplantation Abortion Immuno-suppression 03 medical and health sciences 0302 clinical medicine Obstetrics and gynaecology Pregnancy medicine education reproductive and urinary physiology Transplantation education.field_of_study Ectopic pregnancy business.industry Obstetrics Fetal outcomes Minireviews End-stage liver disease medicine.disease Gestational diabetes Obstetric complications business |
| Zdroj: | World Journal of Transplantation |
| ISSN: | 2220-3230 |
| Popis: | An increasing number of childbearing agewomen undergo liver transplantation (LT) in the United States. Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility, particularly in terms of immunosuppression and optimal timing of conception. Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus. On the other hand, the outcomes of pregnancy in LT recipients are favorable, and children born to LT recipients are relatively healthy. Counseling on pregnancy should start before LT and continue after LT up until pregnancy, while all pregnant LT recipients must be managed by amultidisciplinary team, including both an obstetrician and a transplant hepatologist. Additionally, an interval of at least 1-2 years after successful LT is recommended before considering pregnancy. Pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients. As adverse fetal outcomes, such asmiscarriage, abortion, stillbirth, or ectopic pregnancy, may occur more often than in the non-transplant population, early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications. No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients. |
| Databáze: | OpenAIRE |
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