{"id":9516,"date":"2025-01-16T20:26:32","date_gmt":"2025-01-16T23:26:32","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=9516"},"modified":"2025-01-16T20:26:34","modified_gmt":"2025-01-16T23:26:34","slug":"doencas-hepaticas-especificas-da-gestacao","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/doencas-hepaticas-especificas-da-gestacao\/","title":{"rendered":"Doen\u00e7as Hep\u00e1ticas Espec\u00edficas da Gesta\u00e7\u00e3o"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/9516?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/9516?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p>As doen\u00e7as hep\u00e1ticas na gesta\u00e7\u00e3o compreendem tanto doen\u00e7as hep\u00e1ticas espec\u00edficas gestacionais e desordens hep\u00e1ticas agudas ou cr\u00f4nicas que ocorrem de forma coincidente com a gesta\u00e7\u00e3o.<\/p>\n\n\n\n<p>As doen\u00e7as hep\u00e1ticas espec\u00edficas gestacionais afetam 3% das gestantes e incluem:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pr\u00e9-ecl\u00e2mpsia e s\u00edndrome HELLP (hem\u00f3lise, eleva\u00e7\u00e3o de enzimas hep\u00e1ticas e plaquetopenia);<\/li>\n\n\n\n<li>Hiper\u00eamese grav\u00eddica (HG);<\/li>\n\n\n\n<li>Colestase intra-hep\u00e1tica da gravidez (CIHG);<\/li>\n\n\n\n<li>Esteatose hep\u00e1tica aguda da gravidez (EHAG).<\/li>\n<\/ul>\n\n\n\n<p>Estas desordens requerem imediata investiga\u00e7\u00e3o e manejo com o objetivo de reduzir morbimortalidade materna e fetal, de forma que a identifica\u00e7\u00e3o do tempo gestacional (semanas\/trimestre) \u00e9 fundamental para guiar o racioc\u00ednio cl\u00ednico.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=9521\"><img fetchpriority=\"high\" decoding=\"async\" width=\"979\" height=\"388\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA1.jpg\" alt=\"\" class=\"wp-image-9521\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA1.jpg?v=1736866430 979w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA1-300x119.jpg?v=1736866430 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA1-768x304.jpg?v=1736866430 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA1-585x232.jpg?v=1736866430 585w\" sizes=\"(max-width: 979px) 100vw, 979px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 1. <\/strong>Doen\u00e7as hep\u00e1ticas gestacionais de acordo com o per\u00edodo gestacional (trimestre).<\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Na hist\u00f3ria cl\u00ednica, sempre questionar sobre gesta\u00e7\u00f5es pr\u00e9vias, comportamentos de alto risco, medica\u00e7\u00f5es, suplementos e ervas\/ch\u00e1s.<\/p>\n\n\n\n<p><br>Na avalia\u00e7\u00e3o das doen\u00e7as hep\u00e1ticas na gesta\u00e7\u00e3o, \u00e9 necess\u00e1rio estar atento \u00e0s <strong>mudan\u00e7as fisiol\u00f3gicas e hormonais da gravidez:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Circula\u00e7\u00e3o hiperdin\u00e2mica, com aumento do d\u00e9bito card\u00edaco e do volume plasm\u00e1tico circulante;<\/li>\n\n\n\n<li>Redu\u00e7\u00e3o da resist\u00eancia vascular perif\u00e9rica;<\/li>\n\n\n\n<li>Hiperestrogenismo, podendo manifestar eritema palmar e nevos\/aranhas vasculares;<\/li>\n\n\n\n<li>Laboratorialmente:\n<ul class=\"wp-block-list\">\n<li>AST, ALT, GGT, Bilirrubinas, Protrombina\/INR \u2b95inalterados<\/li>\n\n\n\n<li>Hemoglobina, Albumina \u2b95reduzidas<\/li>\n\n\n\n<li>Fosfatase alcalina, Alfafetoprote\u00edna \u2b95aumentadas<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=9523\"><img decoding=\"async\" width=\"791\" height=\"455\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA-2.png\" alt=\"\" class=\"wp-image-9523\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA-2.png 791w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA-2-300x173.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA-2-768x442.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/01\/FIGURA-2-585x337.png 585w\" sizes=\"(max-width: 791px) 100vw, 791px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><em>*Testes incluem hepatites virais (anti-VHA IgM, anti-HCV, HbsAg, anti-HBc, anti-HEV IgM, Epstein-Barr v\u00edrus, citomegalov\u00edrus e herpes v\u00edrus), FAN, anti-m\u00fasculo liso, IgG, ceruloplasmina; screening de \u00e1lcool e drogas, incluindo paracetamol; anticorpos para doen\u00e7a cel\u00edaca; ultrassonografia de abdome com doppler colorido hep\u00e1tico<\/em><br><br><strong>Figura 2. Fluxograma de investiga\u00e7\u00e3o inicial de altera\u00e7\u00e3o de exames hep\u00e1ticos na gesta\u00e7\u00e3o.<\/strong><\/figcaption><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\" id=\"h-hiperemese-gravidica\"><br><strong>Hiper\u00eamese grav\u00eddica<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Incomum (0,3-2% das gesta\u00e7\u00f5es)<\/li>\n\n\n\n<li>N\u00e1useas e v\u00f4mitos com perda de 5% ou mais do peso pr\u00e9-gestacional, desidrata\u00e7\u00e3o e cetose<\/li>\n\n\n\n<li>1\u00ba trimestre e tipicamente resolve at\u00e9 a 20\u00aa semana<\/li>\n\n\n\n<li>Fatores de risco: gesta\u00e7\u00e3o molar, m\u00faltiplas gesta\u00e7\u00f5es, doen\u00e7a trofobl\u00e1stica, HG pr\u00e9via e anormalidades fetais (trissomia 21, triploidia e hidropsia fetal)<\/li>\n\n\n\n<li>Laboratorialmente:\n<ul class=\"wp-block-list\">\n<li>Eleva\u00e7\u00e3o discreta de AST e ALT, por\u00e9m raramente at\u00e9 20x limite superior da normalidade (LSN) \u2013 50 a 60% das gestantes hospitalizadas<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Riscos ao feto (baixo peso ao nascer, pequeno para a idade gestacional, pr\u00e9-termo, menor Apgar), porem, progn\u00f3stico favor\u00e1vel<\/li>\n\n\n\n<li>Progn\u00f3stico materno:<\/li>\n\n\n\n<li>Manejo\n<ul class=\"wp-block-list\">\n<li>Suporte ambulatorial ou sob regime de interna\u00e7\u00e3o para sintom\u00e1ticos (antiem\u00e9ticos), reidrata\u00e7\u00e3o e corre\u00e7\u00e3o de dist\u00farbios hidroeletrol\u00edticos<\/li>\n\n\n\n<li>Raramente pode-se necessitar de terapia nutricional enteral ou parenteral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-colestase-intra-hepatica-gestacional\"><br><strong>Colestase intra-hep\u00e1tica gestacional<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>0,3-5,6% das gesta\u00e7\u00f5es \u2b95doen\u00e7a hep\u00e1tica gestacional mais frequente<\/li>\n\n\n\n<li>Prurido com predom\u00ednio na regi\u00e3o palmar\/plantar, eleva\u00e7\u00e3o de transaminases e \u00e1cidos biliares; icter\u00edcia (25%).<\/li>\n\n\n\n<li>Fatores de risco: idade materna avan\u00e7ada, hist\u00f3ria de colestase 2\u00aa \u00e0 anticoncepcionais orais, e hist\u00f3ria pessoa ou familiar de CIHG<\/li>\n\n\n\n<li>Laboratorialmente:\n<ul class=\"wp-block-list\">\n<li>Eleva\u00e7\u00e3o de AST e ALT<\/li>\n\n\n\n<li>Diagn\u00f3stico de CIHG \u2b95 n\u00edvel de \u00e1cidos biliares \u226510\u00b5mol\/L (valor de refer\u00eancia, normal &lt;10 em jejum)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>\u00c1cido biliares maternos podem atravessar a placenta \u2b95 ac\u00famulo no feto e l\u00edquido amni\u00f3tico \u2b95 maior risco de morte intrauterina, parto prematuro, mec\u00f4nio e s\u00edndrome do desconforto respirat\u00f3rio neonatal<\/li>\n\n\n\n<li>Progn\u00f3stico materno: excelente<\/li>\n\n\n\n<li>Manejo:\n<ul class=\"wp-block-list\">\n<li>Terapia de 1\u00aa linha: \u00e1cido ursodesoxic\u00f3lico 10-15mg\/kg do peso materno, visando melhora dos sintomas maternos e laboratoriais<\/li>\n\n\n\n<li>Parto at\u00e9 37 semana \u00e9 recomendado<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-doencas-hipertensivas-da-gestacao-pre-eclampsia-eclampsia-hellp\"><br><strong>Doen\u00e7as hipertensivas da gesta\u00e7\u00e3o: pr\u00e9-ecl\u00e2mpsia, eclampsia, HELLP<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pr\u00e9-ecl\u00e2mpsia\/eclampsia (8%)<\/strong> \u2b95 at\u00e9 20% desenvolvem s\u00edndrome HELLP\n<ul class=\"wp-block-list\">\n<li>Dor de cabe\u00e7a, vis\u00e3o emba\u00e7ada, dor abdominal, n\u00e1useas\/v\u00f4mitos e\/ou edema<\/li>\n\n\n\n<li>Crit\u00e9rios de Pr\u00e9-ecl\u00e2mpsia: hipertens\u00e3o de in\u00edcio recente (\u2265140x90mmHg) e protein\u00faria (\u2265300mg\/24h ou \u22651+ prote\u00edna) ap\u00f3s 20 semanas de gesta\u00e7\u00e3o<\/li>\n\n\n\n<li>Pode cursar com envolvimento de m\u00faltiplos \u00f3rg\u00e3os maternos:\n<ul class=\"wp-block-list\">\n<li>Circula\u00e7\u00e3o: hipertens\u00e3o, remodelamento card\u00edaco<\/li>\n\n\n\n<li>Renal: protein\u00faria e inj\u00faria renal aguda<\/li>\n\n\n\n<li>Sistema Nervoso central: dor de cabe\u00e7a, hiperreflexia, dist\u00farbios visuais, eclampsia<\/li>\n\n\n\n<li>F\u00edgado: dor no quadro superior direito, HELLP, hematoma subcapsular, infarto hep\u00e1tico ou ruptura<\/li>\n\n\n\n<li>Hematol\u00f3gico: HELLP<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Ecl\u00e2mpsia:<\/strong> envolvimento neurol\u00f3gico com convuls\u00f5es \u2b95 sulfato de magn\u00e9sio (preven\u00e7\u00e3o)<\/li>\n\n\n\n<li><strong>HELLP:<\/strong> anemia hemol\u00edtica, aumento de enzimas hep\u00e1ticas e plaquetopenia\n<ul class=\"wp-block-list\">\n<li>Hipoperfus\u00e3o placent\u00e1ria \u2b95 libera\u00e7\u00e3o de citocinas, ativa\u00e7\u00e3o da cascata de coagula\u00e7\u00e3o \u2b95 microangiopatia, disfun\u00e7\u00e3o e dano endotelial<\/li>\n\n\n\n<li>Microangiopatia hemol\u00edtica \u2b95 anemia normoc\u00edtica, eleva\u00e7\u00e3o de LDH e bilirrubina, redu\u00e7\u00e3o de haptoglobina<\/li>\n\n\n\n<li>Agrega\u00e7\u00e3o e aglutina\u00e7\u00e3o plaquet\u00e1ria \u2b95 redu\u00e7\u00e3o de plaquetas<\/li>\n\n\n\n<li>Microtrombos na circula\u00e7\u00e3o hep\u00e1tica \u2b95 dano hepatocit\u00e1rio \u2b95 eleva\u00e7\u00e3o de enzimas hep\u00e1ticas<\/li>\n\n\n\n<li>Progn\u00f3stico materno: mortalidade 1-3%; insufici\u00eancia hep\u00e1tica 4,5%<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Manejo:\n<ul class=\"wp-block-list\">\n<li>Corticoide \u2b95 gesta\u00e7\u00e3o &lt;34 semanas (matura\u00e7\u00e3o pulmonar)<\/li>\n\n\n\n<li>Sulfato de magn\u00e9sio<\/li>\n\n\n\n<li>Controle press\u00f3rico<\/li>\n\n\n\n<li>Parto = tratamento curativo \u2b95 antecipar para 36-37 semanas, individualizar<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-esteatose-hepatica-aguda-da-gravidez\"><br><strong>Esteatose hep\u00e1tica aguda da gravidez<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Raro \u2b95 25% podem ocorrer no p\u00f3s-parto<\/li>\n\n\n\n<li>Desde sintomas inespec\u00edficos (n\u00e1useas, v\u00f4mitos e dor abdominal) at\u00e9 insufici\u00eancia hep\u00e1tica aguda (coagulopatia, encefalopatia, ascite)\n<ul class=\"wp-block-list\">\n<li>Quadro pode se sobrepor em vari\u00e1veis cl\u00ednicas e bioqu\u00edmicos com pr\u00e9-ecl\u00e2mpsia e HELLP<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Fatores de risco: gravidez m\u00faltipla e baixo \u00edndice de massa corporal<\/li>\n\n\n\n<li>Etiologia n\u00e3o \u00e9 clara, por\u00e9m, h\u00e1 influ\u00eancia de anormalidades na oxida\u00e7\u00e3o de \u00e1cidos graxos, em especial, da defici\u00eancia de \u00e1cidos graxos de cadeia longa<em> (long-chain fatty acid deficiency \u2013 LCHAD)<\/em>\n<ul class=\"wp-block-list\">\n<li>Feto homozigoto e m\u00e3e heterozigota para <em>LCHAD<\/em> \u2b95 redu\u00e7\u00e3o materna da capacidade de oxidar \u00e1cidos graxos<br>\u2b95 aumento da lip\u00f3lise, em especial, no 3\u00ba trimestre, al\u00e9m de redu\u00e7\u00e3o da beta-oxida\u00e7\u00e3o de \u00e1cidos graxos de cadeia longa \u2b95 ac\u00famulo dos metab\u00f3litos hepatot\u00f3xicos 3-hidroxiacil-coenzima A de cadeia longa desidrogenase produzidos pelo feto ou placenta na circula\u00e7\u00e3o materna e f\u00edgado (esteatose microvesicular)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Laboratorialmente:\n<ul class=\"wp-block-list\">\n<li>Eleva\u00e7\u00e3o de AST e ALT<\/li>\n\n\n\n<li>Aumento de bilirrubinas<\/li>\n\n\n\n<li>Inj\u00faria renal<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Diagn\u00f3stico \u2b95 Crit\u00e9rios de Swansea (Tabela 1)<\/li>\n\n\n\n<li>Manejo:\n<ul class=\"wp-block-list\">\n<li>Parto imediato<\/li>\n\n\n\n<li>Correspond\u00eancia de risco de mortalidade fetal com MELD-score \u2b95 MELD &gt;30 = maior taxa de complica\u00e7\u00f5es<\/li>\n\n\n\n<li>Avaliar necessidade de transplante hep\u00e1tico (raro)<\/li>\n\n\n\n<li>Aconselhamento gen\u00e9tico para rec\u00e9m-nascido (RN) \u2013 <em>screening<\/em> <em>LCHAD<\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-criterios-de-swansea-para-esteatose-hepatica-aguda-gestacional\"><strong>Crit\u00e9rios de Swansea para esteatose hep\u00e1tica aguda gestacional<\/strong><\/h2>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><div class=\"pcrstb-wrap\"><table class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background has-fixed-layout\"><tbody><tr><td><em>Diagn\u00f3stico: presen\u00e7a de 6 ou mais crit\u00e9rios na aus\u00eancia de outros causas<\/em><\/td><\/tr><tr><td>V\u00f4mitos<\/td><\/tr><tr><td>Dor abdominal<\/td><\/tr><tr><td>Polidipsia\/poli\u00faria<\/td><\/tr><tr><td>Encefalopatia<\/td><\/tr><tr><td>Aumento de bilirrubinas                                                                                                                            &gt;0,8mg\/dL<\/td><\/tr><tr><td>Hipoglicemia                                                                                                                                              &lt;72mg\/dL<\/td><\/tr><tr><td>Aumento de \u00e1cido \u00farico                                                                                                                             &gt;5,7mg\/dL<\/td><\/tr><tr><td>Leucocitose                                                                                                                                                 &gt;11.000 c\u00e9lulas\/uL<\/td><\/tr><tr><td>Aumento de transaminases (AST ou ALT)                                                                                                   &gt;42UI\/L<\/td><\/tr><tr><td>Aumento da am\u00f4nia                                                                                                                                   &gt;47\u00b5mol\/L<\/td><\/tr><tr><td>Inj\u00faria renal; creatinina                                                                                                                                &gt;1,7mg\/dL<\/td><\/tr><tr><td>Coagulopatia; tempo de protrombina                                                                                                         &gt;14 segundos<\/td><\/tr><tr><td>Ascite ou f\u00edgado ecog\u00eanico na ultrassonografia<\/td><\/tr><tr><td>Esteatose microvesicular na bi\u00f3psia hep\u00e1tica<\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\"><strong>Tabela 1. Crit\u00e9rios de Swansea para esteatose hep\u00e1tica aguda gestacional<\/strong><\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-informacoes-chave-sobre-as-doencas-hepaticas-gestacionais\"><br><strong>Informa\u00e7\u00f5es-chave sobre as Doen\u00e7as hep\u00e1ticas gestacionais<\/strong><\/h2>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><div class=\"pcrstb-wrap\"><table class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background has-fixed-layout\"><thead><tr><th><strong>Doen\u00e7a<\/strong><\/th><th><strong>Trimestre (semanas)<\/strong><\/th><th><strong>Quadro cl\u00ednico poss\u00edvel<\/strong><\/th><th><strong>Avalia\u00e7\u00e3o Inicial<\/strong><\/th><th><strong>Manejo<\/strong><\/th><\/tr><\/thead><tbody><tr><td>HG<\/td><td><br>1\u00ba<br>(0-12)<\/td><td>&#8211; N\u00e1useas e v\u00f4mitos persistentes<br>&#8211; Perda de peso >5% do peso pr\u00e9-gestacional<br>&#8211; Eleva\u00e7\u00e3o ALT 2-5xLSN<\/td><td>&#8211; Avalia\u00e7\u00e3o de eleva\u00e7\u00e3o de ALT (Figura 2)<br>&#8211; Afastar risco de obstru\u00e7\u00e3o intestinal<br>&#8211; EDA em casos selecionados<\/td><td>&#8211; Hidrata\u00e7\u00e3o<br>&#8211; Corre\u00e7\u00e3o DHE<br>&#8211; Antiem\u00e9ticos<br>&#8211; Dieta enteral\/parenteral em casos selecionados<\/td><\/tr><tr><td>CIHG<\/td><td>2\u00ba ou 3\u00ba<br>(13-28\/29-40)<\/td><td>&#8211; Prurido generalizado (pode predominar em regi\u00e3o palmar e plantar)<br>&#8211; Icter\u00edcia (raro)<br>&#8211; Eleva\u00e7\u00e3o de ALT 1,5-8xLSN<br>&#8211; GGT normal<br>&#8211; Eleva\u00e7\u00e3o de \u00e1cidos biliares<\/td><td>&#8211; Avalia\u00e7\u00e3o de eleva\u00e7\u00e3o de ALT (Figura 2)<br>&#8211; Excluir doen\u00e7as biliares<\/td><td>&#8211; Monitorar \u00e1cidos biliares<br>\u00b0 \u2265 10\u00b5mol\/L = CIHG<br>\u00b0 \u2265 40\u00b5mol\/L = maior risco fetal<br>&#8211; Considerar AUDC 10-15mg\/kg<br>&#8211; Manejo do prurido<br>&#8211; Considerar antecipa\u00e7\u00e3o do parto (at\u00e9 37 semanas)<br>\u2b95<br>risco de \u00f3bito fetal (1-2%)<\/td><\/tr><tr><td>EHAG<\/td><td>3\u00ba ou p\u00f3s-parto (dias)<\/td><td>&#8211; Sintomas inespec\u00edficos (n\u00e1useas, v\u00f4mitos, anorexia)<br>&#8211; Podem ocorrer sinais e sintomas de IAH (ascite, encefalopatia, coagulopatia)<br>&#8211; Eleva\u00e7\u00e3o de ALT 3-15xLSN<br>&#8211; Eleva\u00e7\u00e3o de bilirrubinas 4-15xLSN<br>&#8211; Podem ocorrer:<br>\u00b0 Inj\u00faria renal<br>\u00b0 Hipoglicemia<br>\u00b0 Hiperuricemia<\/td><td>&#8211; Avalia\u00e7\u00e3o de eleva\u00e7\u00e3o de ALT (Figura 2)<br>&#8211; Se sinais de insufici\u00eancia hep\u00e1tica aguda, considerar:<br>\u00b0 Hepatites virais, incluindo herpes<br>\u00b0 <em>Drug-induced liver injury<\/em><br>\u00b0 Hepatite autoimune<br>\u00b0 Doen\u00e7a de Wilson<br>\u00b0 Vascular\/isquemia<br>&#8211; Crit\u00e9rios de Swansea (Tabela 1)<\/td><td>&#8211; Parto imediato<br>&#8211; <em>Materno:<\/em><br>&#8211; Monitorar e tratar complica\u00e7\u00f5es hep\u00e1ticas: encefalopatia, ascite, inj\u00faria renal<br>&#8211; Considerar transfer\u00eancia para servi\u00e7o\/transplante de f\u00edgado<br>&#8211; Vigiar quadro cl\u00ednico\/piora no p\u00f3s-parto<br>&#8211; <em>RN:<\/em><br>&#8211; Monitoriza\u00e7\u00e3o para manifesta\u00e7\u00f5es de defici\u00eancia de 3-hidroxiacil-coenzima A de cadeia longa desidrogenase <br>(hipoglicemia e esteatose hep\u00e1tica)<\/td><\/tr><tr><td><br>Pr\u00e9-ecl\u00e2mpsia\/<br>HELLP<\/td><td><br>&gt;20 semanas\/ &gt;22 semanas<\/td><td>&#8211; Dor de cabe\u00e7a, altera\u00e7\u00e3o visual<br>&#8211; Dor abdominal<br>&#8211; Hipertens\u00e3o<br>&#8211; Eleva\u00e7\u00e3o de ALT 2-30xLSN<br>&#8211; Eleva\u00e7\u00e3o de bilirrubinas 1,5-10xLSN<br>&#8211; Podem ocorrer:<br>\u00b0 Protein\u00faria<br>\u00b0 Plaquetopenia<br>\u00b0 Inj\u00faria renal<br>\u00b0 Aumento LDH<\/td><td>&#8211; Avalia\u00e7\u00e3o de eleva\u00e7\u00e3o de ALT (Figura 2), plaquetas baixas<br>&#8211; Exclus\u00e3o de doen\u00e7as hep\u00e1ticas cr\u00f4nicas e outras causas de insufici\u00eancia hep\u00e1tica<br>&#8211; Imagem abdominal para avaliar a vasculariza\u00e7\u00e3o e sinais de hipertens\u00e3o portal<\/td><td>&#8211; Monitorar complica\u00e7\u00f5es (infarto ou hematoma hep\u00e1tico)<br>&#8211; Ap\u00f3s 36 semanas, considerar antecipa\u00e7\u00e3o do parto<br><em>&#8211; HELLP:<\/em><br>\u00b0 Considerar parto ap\u00f3s 34 semanas<br>\u00b0 Transfus\u00e3o de plaquetas para 40-50.000 c\u00e9lulas antes do parto<br>\u00b0 Considerar transplante hep\u00e1tico em casos graves<\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\"><br>AUDC, \u00e1cido ursodesoxic\u00f3lico; DHE, dist\u00farbio hidroeletrol\u00edtico; EDA, endoscopia digestiva alta; HG, hiper\u00eamese grav\u00eddica; CIHG, colestase intra-hep\u00e1tica gestacional; EHAG, esteatose hep\u00e1tica aguda gestacional; HELLP,<br><em>Hemolysis Elevated Liver enzymes and Low platelet count syndrome<\/em>; IAH, insufici\u00eancia hep\u00e1tica aguda; LSN, limite superior da normalidade<br><strong>Tabela 2. Informa\u00e7\u00f5es-chave sobre as Doen\u00e7as hep\u00e1ticas gestacionais<\/strong><\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-referencias\"><br><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol. 2023 Sep;79(3):768-828. doi: 10.1016\/j.jhep.2023.03.006. Epub 2023 Jun 30. PMID: 37394016<\/li>\n\n\n\n<li>Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):318-365. doi: 10.1002\/hep.31559. Epub 2021 Jan 3. PMID: 32946672<\/li>\n\n\n\n<li>Terrault NA, Williamson C. Pregnancy-Associated Liver Diseases. Gastroenterology. 2022 Jul;163(1):97-117.e1. doi: 10.1053\/j.gastro.2022.01.060. Epub 2022 Mar 8. PMID: 35276220<\/li>\n\n\n\n<li>Tran, Tram T MD, FACG, FAASLD<sup>1<\/sup>; Ahn, Joseph MD, MS, FACG<sup>2<\/sup>; Reau, Nancy S MD, FAASLD, FAGA<sup>3<\/sup>.&nbsp;ACG Clinical Guideline: Liver Disease and Pregnancy. American Journal of Gastroenterology 111(2):p 176-194, February 2016.| DOI: 10.1038\/ajg.2015.430<\/li>\n\n\n\n<li><a href=\"https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/clinical-pearls\/pregnancy-pruritus-and-pain-oh-my-case-based\">https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/clinical-pearls\/pregnancy-pruritus-and-pain-oh-my-case-based<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/clinical-pearls\/it-takes-two-liver-diseases-pregnancy\">https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/clinical-pearls\/it-takes-two-liver-diseases-pregnancy<\/a><\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-como-citar-este-artigo\">Como citar este artigo<\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Oti KST, Doen\u00e7as Hep\u00e1ticas Espec\u00edficas da Gesta\u00e7\u00e3o Gastropedia 2025, Vol. 1. Dispon\u00edvel em: <a href=\"https:\/\/gastropedia.pub\/pt\/?p=9516\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/gastropedia.pub\/pt\/gastroenterologia\/doencas-hepaticas-especificas-da-gestacao\/<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As doen\u00e7as hep\u00e1ticas na gesta\u00e7\u00e3o compreendem tanto doen\u00e7as hep\u00e1ticas espec\u00edficas gestacionais e desordens hep\u00e1ticas agudas ou cr\u00f4nicas que ocorrem de forma coincidente com a gesta\u00e7\u00e3o. As doen\u00e7as hep\u00e1ticas espec\u00edficas gestacionais&hellip;<\/p>\n","protected":false},"author":5590,"featured_media":9532,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[21,18],"tags":[],"ano":[413],"tipo":[121],"volume":[57],"class_list":["post-9516","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-figado","category-gastroenterologia","ano-413","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Doen\u00e7as Hep\u00e1ticas Espec\u00edficas da Gesta\u00e7\u00e3o - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/doencas-hepaticas-especificas-da-gestacao\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Doen\u00e7as Hep\u00e1ticas Espec\u00edficas da Gesta\u00e7\u00e3o\" \/>\n<meta property=\"og:description\" content=\"As doen\u00e7as hep\u00e1ticas na gesta\u00e7\u00e3o compreendem tanto doen\u00e7as hep\u00e1ticas espec\u00edficas gestacionais e desordens hep\u00e1ticas agudas ou cr\u00f4nicas que ocorrem de forma coincidente com a gesta\u00e7\u00e3o. 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