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"Confinement Class" in the south
Case:
The 34 -year -old Xiaomin (pseudonym )’s desire to give birth to the "two treasures" has not been realized, but she and her family are still fortunate.Because she had just experienced a lifetime after a robbery.
Four years ago, Xiaomin gave birth to a son in a cesarean section in the local hospital.After this spring, after her "second child", Xiaomin’s family was happy. In the local hospital, she had a birth check -up step by step.It was broken until about 26 weeks of pregnancy.Recalling the scene behind, Xiaomin’s family took a breath.
Because of uncomfortable, some headache and brain are hot, Xiaomin went to the local hospital for consultation, fearing that the western medicine prescribed by the doctor would affect the fetus. Xiaomin also found a Chinese medicine medicine near home and prescribed some Chinese herbal medicine to take it.
After 2 days after taking the medicine, her mother -in -law and husband suddenly found that Xiaomin’s skin and eyes were yellow.
Hurry to find her inspection doctor. Once the inspection was checked, Xiaomin liver function was obviously abnormal. The hospital quickly transferred her to the third hospital affiliated to Sun Yat -sen University. This is the center of pregnancy with severe diseases of pregnancy in Guangdong Province.
Xiaomin, who was lying in the ICU of Zhongshan Third Hospital, was diagnosed with pregnancy and liver failure, and some people called it as a pregnancy -induced hepatitis.The hospital immediately performed the treatment of liver protection and infusion of blood products while improving the relevant examination. After 5 days, Xiaomin’s situation did not improve, liver atrophy, necrosis, and the speed of the entire disease was quite fast.
The hospital organized a multi -disciplinary consultation of the hospital on the condition of Xiaomin. Experts reached a consensus consensus that liver transplantation must be performed as soon as possible. Otherwise, the children were hopeless and adults could not keep it.
"It can be said that any disease encounters pregnancy and childbirth, which will undergo qualitative changes, and the severity of the condition will be upgraded."Fan Jianhui, a member of the Guangdong Provincial Society and Deputy Director of the Obstetrics at the Third Hospital of Sun Yat -sen University, participated in the whole process. She said, "This is a very typical case of pregnancy and liver failure, which is very dangerous."Essence
Fortunately, the next day, the next day, with the appropriate liver source to Xiaomin, the obstetrics, liver transfer department, anesthesiology department, ICU and other related departments jointly formulated a treatment plan for Xiaomin: first liver transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation, after transplantation,Liver function and coagulation function will be improved, and then the obstetrics will perform induction surgery.
Unexpectedly, after the transplantation was successful, more than ten hours, 6-7 hours from the induction of labor, Xiaomin’s lower body began to bleed, the fetus was naturally aborted, and the amount of bleeding was 1600 ml.
After emergency treatment, the obstetrics were busy again and performed uterine resection for Xiaomin.Later, he was discharged by the treatment of rehabilitation.
When the treatment comes to an end, what factor causes Xiaomin liver failure?
"We did not find that the mother had hepatitis virus infection after doing various examinations. Comprehensive analysis was considered as: medicinal liver damage during pregnancy."Dr. Fan said.
"Two children" liberalized, increased critical illness in pregnancy
Since the "two -child" policy, patients with various pregnancy and critical illnesses have increased, and liver failure is also one of them.
"Our hospital is the center of pregnancy with severe diseases in Guangdong Province. The infection department, liver movement department, and obstetrics have rich experience and technologies." Statistics show that the mortality rate of pregnancy and liver failure is as high as 60%to 90%. In recent years, the disease mortality reported in China is 43%to 80%, which is one of the main reasons for the death of pregnant women in my country.The patients of chronic hepatitis B in my country have reached 93 million. Guangdong is a large province of hepatitis B. It is also hoped that the public can pay attention to the health of liver during pregnancy.The burden on the liver during pregnancy is worsened, and the mother B mother is risky and must be monitored.
Xiaomin’s situation is relatively special. In comparison, "We are more common in clinical clinical is that hepatitis B pregnancy mothers have acute liver failure during pregnancy."
Professor Fan introduced that the first cause of pregnancy in my country with liver failure is viral hepatitis, which is mainly based on hepatitis B virus infection. Infection, autoimmune liver disease, liver toxic substances and unknown causes.
During pregnancy, the burden on the liver is worsened
Professor Fan further mentioned that the metabolic rate of women during pregnancy increases, and the metabolism and detoxification effects of the fetus also mainly depend on the completion of the liver of pregnant women. In addition, the level of estrogen during pregnancy needs to be used to metabolize and live in the liver.The ability to operate fat and the ability to excrete bile, so the liver burden of pregnant women is relatively heavy, and it may have a large response.
In short, the liver of pregnant women during pregnancy is a large or potential damage factors during pregnancy, especially in the late pregnancy. Due to the changes in the abdominal pressure of the pregnant woman, the liver blood flow will also be affected.
"It can be seen clinically that people who are healthy and have no abnormalities in the liver have certain differences before and after pregnancy, although they are within the normal value range."Fan Jianhui said that the patient Xiaomin in this article did not have hepatitis B before and after pregnancy, and the liver was normal. Due to some causes, the liver function was severely damaged.Therefore, everyone needs to pay attention to liver health.
Encourage breastfeeding and provide a effective barrier for your baby
Whether the baby of hepatitis B positive mothers can breastfeed is a question that many people care about.
"As a doctor, it is definitely encouraging breastfeeding." Dr. Fan emphasized that no matter whether it is "Da Sanyang" and "Little Sanyang", breastfeeding is recommended because joint immunity provides a protective barrier for babies.
Although some hospitals are testing the hepatitis B virus in breast milk, so far, no evidence has shown that breastfeeding does increase the risk of transmitting hepatitis B virus to the baby.
The research team led by Associate Professor Zheng Yingjie of the Ministry of Public Health and Safety Education, Fudan University, has been studied for breastfeeding of infants who have been vaccinated with routinely vaccination.And the title of "Hepatitis B mother can breast milk?" It has been published in the "Biomedical Center · Public Health" of Public Health Authoritative Magazine London.
Some retrospective studies have shown that the hepatitis B mother breastfeeding baby’s hepatitis B infection rate is not different from artificial feeding.The World Health Organization (WHO) also recommends mothers of hepatitis B surface antigen positive (HBSAG) for breastfeeding.
How to reduce the risk of pregnancy before and after pregnancy
Pregnancy with liver disease, once it is very dangerous, how to avoid it?Professor Fan suggested that starting from preparing for pregnancy, he should pay attention to liver health and regular examination.
Preparation before pregnancy: Some mothers who prepare for the "two -child", the first child and the second interval for a long time, often ignore liver health problems, so it is recommended to do related examinations before pregnancy, including liver function, virus load, imaging science, imaging scienceB -ultrasound, if all indicators are normal, even if the virus is high, the liver function is normal, but the liver’s machine is still operating normally, which will not affect pregnancy.
However, if the liver function is severely damaged before pregnancy, it is recommended to take related treatment in this case.When the liver function returns to normal, it is recommended to get pregnant.
During pregnancy: during pregnancy, examination, including hepatitis virus and liver function regularly, if it is pregnancy combined with hepatitis B, liver cirrhosis, or other liver -related diseases.During pregnancy, a standardized check-up must be conducted in regular hospitals, and the liver function is scheduled regularly every 1-2 months. Once abnormalities are found, they are treated early.
Hepatitis is lighter and medium, mild can be used in household medicine, and is hospitalized in moderation.If the volume of hepatitis B virus is high, the obstetrics and infection are needed to formulate antiviral treatment plans for pregnant women.
◇ Special reminder
Use Chinese herbal medicine carefully during pregnancy
Mother Xiaomin in this article belongs to a drug -induced liver damage that occurs during pregnancy. When the doctor was looking for the cause, the doctor found that she was suspected of taking the unknown Chinese herbal medicine during pregnancy.
Some pregnant women believe that abuse western medicine may cause miscarriage or fetal malformations, and think that taking Chinese medicine is safe, so once physical discomfort, it often finds Chinese medicine for help.In fact, pregnant women are also unsafe in taking Chinese medicine, because they will also cause various adverse consequences.
Xu Jinghang, deputy chief physician of the Department of Infectious Diseases of Peking University Hospital, introduced that "drug -induced liver damage", as the name implies, is liver damage related to drugs, that is, whether it is the drug itself or the metabolites of the drug, it is different.The way to damage our liver, this situation is drug -based liver damage.
Since there is medicine, drug -induced liver damage is inevitable. Both western medicine and Chinese medicine may cause liver damage.From the perspective of the onset, some people have done such statistics that about 10%of patients with acute liver damage to inpatient patients are pharmaceutical liver damage.
A number of domestic clinical studies have shown that Chinese medicines in drugs that cause drug -based liver injuries are the most common pathogenic factor.An article published in the authoritative magazine "Chinese Gastroenterology" in 2007. The author analyzes the case of liver damage from 16 hospitals in 13 regions from 2000 to 2005. The data tells us that the liver damage caused by Chinese medicine is occupiedThe proportion is more than 20%, which is the proportion of about 1/5, which is the case where Chinese medicine causes liver damage.
Like Lei Gongjo and He Shouwu have obvious side effects of liver damage, others include Fanxieye, five -fold, and thousands of miles, etc. These traditional Chinese medicines may cause liver damage.
Fan Jianhui, deputy director of the obstetrics department of the Third Hospital of Sun Yat -sen University, reminded that during pregnancy, whether it is western or Chinese medicine, it should be taken under the guidance of a doctor. Chinese herbal medicine with unknown composition should be eliminated.
Southern Daily reporter Li Yan
