Qual É o Tratamento da Esteatose Hepática Aguda da Gravidez?
Cenário Clínico
A esteatose hepática aguda da gravidez (EHAG) é uma complicação hepática rara e grave do terceiro trimestre que requer tratamento urgente e coordenado. O diagnóstico rápido e a ação imediata são essenciais para reduzir o risco materno e perinatal.
Abordagem Terapêutica
O tratamento de primeira linha envolve a correção de alterações metabólicas críticas como prioridade imediata, seguida do parto expedito — com a via de parto determinada através de avaliação multidisciplinar. A sequência completa e o enquadramento decisional encontram-se no protocolo completo.
Objetivos do Tratamento
O sucesso é medido pela normalização dos níveis das enzimas hepáticas e pela recuperação rápida da função renal no período pós-parto.
References
DOI: 10.1016/j.jhep.2023.03.006
- Delivery should be expedited once coagulopathy and remediable metabolic derangements have been treated, and decisions about mode of delivery should be made jointly by obstetricians, hepatologists and the multidisciplinary team.
- Current recommended practice is to ensure coagulopathy, hypoglycaemia and metabolic acidosis are stabilised/corrected and then to expedite delivery of the fetus in women diagnosed with AFLP antenatally.
- In AFLP, small observational studies found that caesarean section is associated with improved maternal and perinatal outcomes compared to vaginal delivery.
- Nonetheless, generally rapid delivery after stabilisation of hypoglycaemia, acid-base balance and coagulopathy is recommended.
- However, when fetal demise has occurred, expedited vaginal induction could be considered (instead of caesarean section).
- Hepatocellular necrosis was demonstrated to peak at the time of delivery and showed prompt recovery with reduction of liver transaminase measurements to <100 IU/L by the second or third day postpartum.
- In a similar fashion, recovery of renal function was prompt after delivery.
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