title: Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia.
abstract: OBJECTIVE
  To describe the management of prenatal care and delivery in patients bearing autoimmune hepatitis associated with moderate or severe thrombocytopenia.
  
  
  METHODS
  This study was performed in a tertiary level university hospital. Thirteen pregnancies in ten patients diagnosed with autoimmune hepatitis, complicated by thrombocytopenia, were retrospectively analyzed. The inclusion criteria were as follows: clinical diagnosis of autoimmune hepatitis, moderate or severe thrombocytopenia (platelet count < 100 x 103/mm3), gestational age at birth over 22 weeks, and patient followed-up by a specialized team at the institution. The variables studied were: maternal age, parity, treatment regimen, platelet count, examinations for investigation of hepatic function, type of delivery, weight at birth, and gestational age at the time of delivery.
  
  
  RESULTS
  The average maternal age was 24.5 years (SD = 5.3) and six (50%) occurred in nulliparous women. During pregnancy, monotherapy with prednisone was adopted in 11 cases (92%). According to the autoantibody profiles, seven pregnancies (58%) had the autoimmune hepatitis type I diagnosis, two pregnancies had type II (17%), and three pregnancies (25%) had cryptogenic chronic hepatitis (undetectable titers of autoantibodies). Portal hypertension was featured in 11 pregnancies (92%). The average gestational age at delivery was 36.9 weeks (SD = 1.5 weeks), with an average weight at birth of 2,446 g (SD = 655 g). Eight infants (67%) were small for gestational age. At the time of delivery, severe thrombocytopenia was featured in four cases (33%) and cesarean surgery was performed in seven cases (58%). Complications at delivery occurred in three cases (25%), one patient presented uterine atony, and two patients presented perineal bruising. There was no perinatal or maternal death.
  
  
  CONCLUSIONS
  The complications of thrombocytopenic patients with autoimmune hepatitis are elevated; nevertheless, with appropriate attention and care, they can be resolved. The association between two severe pathologies appears to increase the risk of prematurity and fetal growth restriction, demanding specialized prenatal care, as well as surveillance of newborn well-being.
authors: Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. roseli.nomura@hotmail.com
authors: Roseli Mieko Yamamoto
authors: RM
authors: Nomuras
authors: Rodolpho Truffa
authors: RT
authors: Kleine
authors: Ana Maria Kondo
authors: AM
authors: Igai
authors: Rossana Pulcineli Vieira
authors: RP
authors: Francisco
authors: Marcelo
authors: M
authors: Zugaib
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D005865:Gestational Age; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000209:etiology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications*