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Obstetrical Management of Fulminant Viral Hepatitis in Late Pregnancy

Zhongjie Shi, Xiaomao Li, Yuebo Yang, Lin Ma and Ann Schreiber

Objective: To set up a routine perinatal treatment guideline for fulminant viral hepatitis in late pregnancy (FVHLP). Method: A summary of literature of successful treatment at various clinical stages. Due to the limited number of prospective studies, retrospective, observational studies and case reports were analyzed and pathophysiological mechanisms were summarized as well. Results: A comprehensive obstetrical treatment guideline was proposed as follows: (a) Awareness of FVHLP should be reinforced among medical staff; (b) Patients diagnosed with FVHLP should be transported to regional expert centers before labor onset; (c) Supportive medication should be administered to prepare the patients for incoming delivery. A central venous line should be maintained to provide rapid intravenous access and monitor central venous pressure before operation start; (d) Caesarean section is recommended for the mode of delivery, followed by peripartum hysterectomy to control postpartum hemorrhage; (e) Peritoneal/abdominal lavage and drainage tube placement are recommended following operation to decrease abdominal pressure and detect post-operational bleeding; (f) Hypertonic glucose along with insulin topical injection is recommended to promote the healing of wound; (g) Supportive medication, replenishment of coagulation factors, preventive antibiotics should be given as needed. Adjust the amount and order of intravenous fluid according to the character and amount of drainage and urine. Conclusion: Vital obstetrical measures taken include supportive treatments, delivery at appropriate time by cesarean section, and prevent and control of various complications. Guidelines developed with more robust research are still needed