Fetal intestinal perforation and meconium peritonitis associated with maternal autoimmune hepatitis

Abstract

Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.

Systematic review with meta‐analysis: outcomes of pregnancy in patients with autoimmune hepatitis

“…Seven studies addressed the disease activity change during pregnancy and mortality information, four addressed the comparison of pregnancy outcomes between different drug therapies, three population‐based cohort studies addressed the comparison of complications after delivery between AIH and matched non‐AIH populations. IPD from 26 case reports/series was extracted for systematic review 28–53 while no RCT was found. Five national cohort studies 25–27,54,55 were screened during literature searching and all of them were population‐based (AIH vs non‐AIH) among which, three were from Sweden 26,54,55 .…”

“…For the systematic review, a total of 16 case reports, 10 case series (sample sizes ranging from 2 to 7) published between 1960 and 2018 were screened 28–53 . IPD from each study was collected using a pre‐designed form.…”

Predicting poor outcomes and the need for surgical treatment in neonates with meconium peritonitis

“…The co-occurrence of MP and ICP has not been reported in previous studies, but there are six reported cases of fetal MP associated with maternal hepatic diseases in the literature. [24][25][26][27][28] In view of a possible association between maternal ICP and fetal MP, perhaps, serial ultrasound surveillance in pregnancies with ICP should be considered for early detection of fetal MP, and vice versa; perhaps, maternal serum total bile acid level should be monitored in patients with MP.…”