What is observed as a result of gastro-intestinal system (GIS) smooth muscle relaxation with progesterone?

  • Reduced intestinal motility

  • Reflux esophagitis

  • Decreased gastric acid secretion, increased mucus secretion

  • Increased gastric volume

Which changes can be observed on the laboratory findings in hyperemesis gravidarum (HG)?

  • Prerenal azotemia due to severe dehydration

  • Hypokalemia due to hydrochloric acid loss

  • Hyponatremia, hypocalcemia

  • Ketonemia, ketonuria

  • High creatinine level

  • Hyperbilirubinemia and deterioration in liver function tests

What are the complications of HG?

  • Mallory Weiss tears/lacerations

  • Vitamin K deficiency (coagulopathy, epistaxis)

  • Wernicke’s encephalopathy (due to thiamine deficiency)

What is the treatment of hyperemesis gravidarum?

  • Fluid-electrolyte replacement

  • Dietary recommendations

  • Ginger

  • Pharmacological treatment

    • Vitamin B6 + doxylamine

    • Antiemetics (promethazine, chlorpromazine, metoclopramide; if necessary ondansetron)

  • Hospitalization

What are the recommendations for the treatment of gastroesophageal reflux (GER)?

  • Adjustment of maternal head position

  • Antacids

  • Histamine H2-receptor antagonists (H2 receptor blockers)

  • Proton pump inhibitors (PPI)

What are the most common causes of abdominal surgery during pregnancy? Explain.

  • The frequency of appendicitis in pregnancy does not increase, even decreases. However, it is difficult to diagnose because the appendix changes its position.

  • Therefore, complication rates and mortality increase.

  • Especially in the last trimester the risk of perforation is much higher.

What are the main features of the intrahepatic cholestasis of pregnancy?

  • Itching is the most common symptom, especially occurs in the third trimester and then jaundice develops.

  • Hyperbilirubinemia is moderate (<4–5 mg/dL).

  • AST, ALT, and LDH levels are elevated.

  • ALP is elevated.

  • Bile acid levels increase by tenfold.

  • The exact cause is unknown.

  • Preterm delivery, meconium staining of amniotic fluid, fetal demise.

  • More common in second trimester, the risk increases near term.

  • Deliver at 38th week.

Explain the treatment of intrahepatic cholestasis of pregnancy.

  • Antihistamines

  • Cholestyramine (bile acid-binding resin)

  • Phenobarbital

  • Dexamethasone

  • S-Adenosyl methionine

  • Ursodeoxycholic acid (UDCA) relieves pruritus, but a favorable effect on fetal/neonatal outcome has not been demonstrated.

  • Itching disappears 3–7 days after birth

What are the main features of the acute fatty liver (AFL) of pregnancy?

  • The most common cause of acute hepatic failure in pregnancy.

  • Although the cause is not known, sometimes “3OH acyl coenzyme A dehydrogenase” deficiency may be detected.

  • There are fat micro vesicles, small collections of fat within the liver cells.

  • No tendency to recur.

  • Nulliparity, multiple pregnancy, and male fetus are factors related with increased risk.

  • Occurs in the third trimester or early postpartum period.

  • Consider in unexplained liver failure near term.

  • It often accompanies signs and symptoms of preeclampsia, and its clinic presentation can be very similar to HELLP syndrome especially.

  • Hypoglycemia and hepatic coma may develop rapidly.

  • The definitive treatment is delivery.

  • If no complications are developed, no sequel is expected.

What is the prognosis of acute fatty liver (AFL) in pregnancy?

  • Maternal mortality rates may reach to 75%.

  • Fetal mortality is about 90%.

Which type of hepatitis have worse prognosis in pregnancy?

  • Hepatitis E

What should be given to the newborn to HbsAg-positive mother?

  • Hepatitis vaccine (to every baby) and hepatitis immunoglobulin (within 12 h of birth)