Hepatitis und Schwangerschaft¹

Abstract

In einer vorausgehenden Veröffentlichung haben wir über die Auswirkung der Hepatitis auf die Frucht berichtet. Diese Veröffentlichung hat zum Ziel. an Hand eines größeren eigenen Krankengutes und einer Durchsicht des Schrifttums fest zustellen, wie die Schwangerschaft und Hepatitis, sich gegenseitig beeinflussen und welche Folgerungen aus diesen Beobachtungen zu ziehen sind.Bei der Durchsicht des älteren Schrifttums überrascht zunächst die hohe Letalität der Hepatitiskranken während der Schwangerschaft. K e r c k si g ist wohl der erste, der 1799 auf den schweren Verlauf der Hepatitis während der Schwangerschaft hingewiesen hat. Er beschrieb eine Epidemie in Lüdenscheidt, bei der 5 schwangere Frauen 1 Auszugsweise vorgetragen auf der 4. Internationalen Konferenz für Geogr. Pathologie in Lüttich. erkrankten, von denen 3 einen Abort hatten ünd 2 verstarben. 1859 bzw. 1862 berichteten B n 11 o t und S a i n t -Ve 1 unabhängig voneinander über eine Gelbsuchtepidemie auf Martinique. Die Beschreibung

The hepatitis A virus infection

“…The above-mentioned studies were done before a serologic distinction between HBV and HAV infections was possible, and some of the patients included probably had jaundice of other causes. However, this does not invalidate the conclusion drawn by Martini et al (160) that neither the attack rate nor the severity of hepatitis was increased in pregnant German women.…”

“…During epidemics of infectious hepatitis, the frequency of fulminant hepatitis reported varies from about one per 100 to one per 1000 patients with clinical hepatitis (16,133,137,154,155). A considerably higher frequency in pregnant women has been reported from Asia (156,157) and the Middle East (158), but studies from Europe (159,160)…”

“…During epidemics of infectious hepatitis, the frequency of fulminant hepatitis reported varies from about one per 100 to one per 1000 patients with clinical hepatitis (16,133,137,154,155). A considerably higher frequency in pregnant women has been reported from Asia (156,157) and the Middle East ( 158), but studies from Europe (159,160) and the United States (161) have not shown pregnancy to be of importance for the development of fulminant hepatitis. It cannot be verified whether these cases of fulminant hepatitis were indeed due to HAV, but recently Rakela et al ( 45) reported serologic evidence of HAV infection in six out of 42 HBsAg negative patients and in one out of 30 HBsAg positive patients with fulminant hepatitis from different parts of the United States.…”

“…Pregnancy has been suspected of involving a marked increase in severity of HAV infections, but the data obtained in Asia (156,157), and the Middle East (158) have not been confirmed in Europe (160) and the United States (161). In his review of the literature, Haemmerli (159) concluded that besides sampling errors, a poor nutritional state during pregnancy and not pregnancy itself probably was responsible for the markedly increased mortality rate.…”