Медикаментозные поражения печени во время беременности

Abstract

The significant frequency of drug-related liver damage during pregnancy, the lack of unified approaches to forecasting issues, the standards for diagnosis and drug correction, as well as the underestimation of the risk of disease for pregnancy outcomes characterize this problem as highly relevant and significant for modern obstetrics. Any drugs in a pregnant woman can cause drug hepatitis, so all of them should be prescribed to pregnant women only for strict clinical indications. In this case, one should take into account the genetic predisposition, history and risk factors for the development of the disease, avoid polypharmacy and adjust the dose and route of administration of the drugs used (especially hormonal ones) based on the state of the liver. If the liver indices deviate from the norm, careful monitoring of drug therapy with a monthly or more frequent determination of the level of serum transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase and bilirubin is necessary. The tactics of managing pregnant women with drug-induced hepatitis requires high medical responsibility when deciding whether to prolong the pregnancy or to terminate it, on the possibility of breastfeeding, determining the type of delivery, anesthetic management and managing the patient in the postpartum period. Key words: drug-induced liver damage, hepatotoxicity, pregnant cholestatic hepatosis, acute fatty hepatosis, HELLP-syndrome, estrogens, progestogens, sublingual progesterone, parenteral progesterone, hepatoprotectors.