GIT, liver +mental health

Severe complications of HG

malnutrition

affects fetal growth (IUGR)

Renal impairment

Dehydration

electrolyte imbalance

weight loss

ketosis

Negatively affect Mental health

Loss of work

Ketosis

Sign that mother and fetus are not getting enough energy fuel in their diet

ketones are metabolic end products of fatty acid metabolism

Body using fat for fuel instead of glucose

may affect babies developing brain cells

How to assess the severity of HG

Pregnancy-unique quantification of emesis and nausea (PUQE)

Non-Pharmacological Treatment for NVP

Reassurance and empathy

Vitamin B

Ginger

Small and frequent snacks

Address fatigue

Discontinue prenatal vitamins with iron

Pharmacological Treatment for NVP

Try to avoid until 14 weeks

Doxylamine

Promethazine

Prochloroperazine

Metoclopramide

Ondansteron

GERD (gastroesophageal reflux disease)

stomach acid or bile irritates the food pipe lining

very common especially later in gestation

Treatment for GERD

-Lifestyle changes → small frequent meals, eat upright, eat slowly, avoid spicy/v acidic foods

Antacids

-Acid lowering drugs → H2 blockers, PPI, antacids

Further investigations

IBS (irritable bowel syndrome)

Abdominal pain or discomfort

altered bowel habits and bloating or distention

IBS and pregnancy

can cause increased constipation, heartburn, nausea and stool frequency

Changes in ovarian hormones and physical pressure of growing fetus on bowel wall may contribute to GI symptoms

IBD (inflammatory bowel disease)

severe inflammation of the intestinal tract

Crohns disease

Ulcerative colitis

Crohn's disease

a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon

Affects all layers of the bowel

ulcerative colitis

chronic inflammation of the colorectal mucosa, with ulcerations

IBD in pregnancy

- Can improve symptoms due to inhibition of inflammation, but can be exacerbated during pregnancy

- should stay on meds

- can affect the development of a baby's GIT leading to mild intestinal inflammation

- main concern is malnutrition, inadequate weight gain and IUGR

- Women with active disease or who have had colon surgery normally have C/S due to risk a vaginal delivery can result in an anal sphincter injury

Anal incontinence

Indirect and direct trauma following vaginal birth can negatively impact the pelvic floor function increasing risk of AI

Liver function

-Production of bile, certain blood plasma proteins, cholesterol

-Storage of excess glucose in the form of glycogen

-*detoxification and degradation of body wastes and hormones

break down RBC

-Controlling infections by boosting immune factors and removing bacteria.

liver anatomy

Portal vein

Responsible for directing blood from parts of the GI tract to the liver. Absorbed nutrients are then absorbed, stored or detoxified

Intrahepatic cholestasis of pregnancy

A condition where bile cannot flow from the liver to the duodenum

Most common liver disease in pregnancy

T3 with pruritis and high Bile acid levels

Types of ICP

Obstructive where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy

Metabolic: disturbances in bile formation that can occur because of genetic defects (transporters) or acquired as a side effect of medications

risk factors for ICP

HCV-positive pregnant woman

Seasonal onset (winter)

Low selenium levels

Low vitamin D

Multiple gestations

Advanced age >35years

Genetic defects in canalicular transporters

Treatment for ICP

Ursodeoxycholic acid (UDCA)

Provides cytoprotection against the hepatotoxic effects of the hydrophobic bile acids and improves hepatobiliary bile acid transport

ICP and birth outcomes

associated with increased rates of preterm birth, meconium-stained amniotic fluid, fetal hypoxia, prolonged admission to the neonatal unit, and stillbirth

HELLP syndrome

hemolysis, elevated liver enzymes, low platelets

Develops in women with severe pre-eclampsia

Placental dysfunction causing Abnormal oxidation of fatty acids by the fetus and release of metabolic intermediates into the mother's circulation cause liver and vascular dysfunction

HELLP syndrome symptoms

nausea, vomiting, viral like illness, epigastric pain, headache, weight gain

HELLP syndrome management

hospitalization

lower BP

prevent with mag sulfate

correct coagulopathies

blood or FFP to treat hemolytic anemia

steroids for fetal lungs

prepare for preterm delivery

Acute fatty liver of pregnancy

abnormal accumulation of triglycerides

Changes to GIT with pregnancy

Propulsion, digestion and elimination slow down due to the effected of hormones on smooth muscles (Relaxing them)
Lower Oesophageal sphincter tone is also reduced
The uterus compresses teh duodenum and stomach
More susceptible to nausea, vomiting, reflux, constipation and diarrhoea

Hyperemesis Gravidarum (HG)

extreme nausea and vomiting during pregnancy 1.2% affected

Nausea and vomiting in pregnancy

Begins at 4 weeks, peaks at 9 and gone by 20
70% affected