Liver transplant and pregnancy.
Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina, USA.
Advances in transplantation medicine present the perinatal health care provider with a unique challenge: care of the woman during pregnancy after organ transplantation. Pregnancy in liver transplant recipients is complicated by hypertension, preeclampsia, anemia, and preterm birth. Neonates born to women after liver transplant are not at increased risk for congenital anomalies. Evidence to date supports that pregnancy does not have a deleterious effect on hepatic graft function or survival if the woman has stable hepatic function before pregnancy. The article focuses on the issues involved with perinatal management of the woman who is a liver transplant recipient.
Acute fatty liver of pregnancy.
Simpson KR. Luppi CJ. O'Brien-Abel N.
Women and Children's Care Center, St John's Mercy Medical Center, St Louis, Missouri, USA.
Acute fatty liver is a rare but potentially fatal complication of the third trimester of pregnancy. Significant improvements in morbidity and mortality have been reported in the last several years. Despite accumulation of more data about the disease, the exact pathogenesis is unknown. Many women are initially misdiagnosed with other more common causes of liver dysfunction during pregnancy. It is possible that acute fatty liver is an atypical form of preeclampsia because 30% to 40% of women with acute fatty liver also have preeclampsia. Supportive care and expeditious delivery represent the only known treatment. More data are needed about acute fatty liver of pregnancy, but the rare nature of the disease and the likelihood that most cases are not reported in the literature limit the ability systematically to study causation, disease process, and treatment options. Because of the serious condition of most women who develop acute fatty liver of pregnancy, collaboration between critical care and perinatal care providers is essential for optimal maternal-fetal outcomes.
Nesidioblastosis: a case study.
Kistler CH. Spiering K.
Family Birthing Center, Jewish Hospital Kenwood, USA.
Hypoglycemia is a frequent problem in the neonatal period requiring close attention and intervention. Severe, persistent hypoglycemia can have various etiologies; one of the most common causes is hyperinsulinism. Nesidioblastosis, although rare, is the most common cause of hyperinsulinism in the neonate. If not detected early, nesidioblastosis can lead to brain damage and death secondary to severe hypoglycemia. The etiology of nesidioblastosis remains unclear. Treatment involves maintaining normal blood glucose levels; treatment modalities include high glucose infusion rates, use of medications, and surgical intervention. The article reviews the pathophysiology and treatment modalities for nesidioblastosis. A case study is also presented that describes the clinical presentation, treatment, surgical intervention, and postdischarge clinical course of an infant with nesidioblastosis.