Clinical Study Of The Relationship Between Alterations Of Liver Function Indices And Maternal And Fetal Outcomes In Hepatitis B Virus In Pregnancy

OBJECTIVE : Study the relationship between alterations of indices of liver function test and maternal and fetal outcomes in pregnants with hepatitis B virus.METHOD Retrospective analysis 46 cases of hepatitis B virus in pregnancy, who had been admitted to Xiangya Hospital between January 2002 and December 2008. Record patients' age, gestational age , liver function test, maternal and fetal outcomes such as maternal mortality, postpartum haemorrhage, hepatic encephalopathy, hepatorenal syndrome, pregnancy-induced hypertension syndrome, fetal mortality, neonatal asphyxia, meconium-staining amniotic fluid. Analyse the relationship between the common indices of liver function test and maternal and fetal outcomes.RESULT (1) In these 46 pregnants, the age ranged from 21 to 35 years old, the mean age was 28.2±3.7 years old. There were 5 cases whose gestational age were less than 28 weeks (196 days); 22 cases over 28 weeks (196 days) to 37 weeks (258 days); 19 cases over 37weeks (259 days). There were 40 primiparas and 6 multiparas, and 6 twin pregnancies, 40 singletons. (2) There were 52 fetuses in total. In these fetuses , 6 cases' gestational age were less than 28 weeks (196 days), and all died (100%); 27 cases' gestational age were over 28 weeks (196 days) to 37weeks (259 days), 5 cases died (18.5%). 19 cases' gestational age were over 37 weeks (259 days), no case died (0%). (3) In the 46 pregnants, the most common clinical manifestation were Anorexia (45.7%) , fatigue(39.1%) , nausea(30.4%), yellow urine(28.3%) , vomitting(17.4%), pruritus(15.2%), abdominal distension(6.5%), oliguria(6.5%). The most common physical symptoms were jaundice(54.3%), lower extremity edema(13.0%), unconsciousness (10.9%), ecchymosis(6.5%). (4) In comparison with the survxc ytyghival group , the concentration of serum albumin was lower, and total bilirubin, total bile acid was higher in death group(P<0.05); There was no significant difference in ALT and AST between the two groups(P>0.05). (5) Mortality, the incidence of postpartum haemorrhage, hepatic encephalopathy in hypoalbuminemia group, high total bile acid group, and high total bilirubin group's pregnants' were higher than their control group respectively(P<0.05), there was no significant difference in the incidence of hepatorenal syndrome, pregnancy-induced hypertension(P>0.05). (6) There was no significant difference between high ALT or AST group and their control group in maternal mortality, the incidence of postpartum haemorrhage, hepatic encephalopathy, hepatorenal syndrome and pregnancy-induced hypertension (P>0.05). (7) In comparison with the control group, hypoalbuminemia group, high total bile acid group and high total bilirubin group were higher in fetal mortality, neonate asphyxia, and meconium-staining amniotic fluid, and were lower in the rate of full-term birth (P<0.05). (8) In comparison with the control group, the higher ALT or AST group were higher in the incidence of fetal mortality and neonate asphyxia, and were lower in the rate of full-term birth (P<0.05). There were no significant difference between high ALT or AST and their control groups in meconium-staining amniotic fluid (P>0.05).CONCLUSOIN: 1. The level of serum albumin, total bilirubin, total bile acid are related to the mortality, postpartum haemorrhage, hepatic encephalopathy in pregnant with hepatitis B. 2.The level of serum albumin, total bilirubin, total bile acid in pregnant are related to fetal mortaliy, meconium- staining amniotic fluid, fetal death, and lower full-term birth rate. 3. Maternal albumin, total bilirubin and total bile acid can predict maternal and fetal outcome in hepatitis B virus in pregnancy.