Dr Alison De Maio
NCHD to Dr. B. Byrne
Consultant Obstetrician
Coombe Hospital Dublin
HPV
HPV is a group of viruses linked to cervical cancer and genital warts
All sexually active women are exposed to the virus
Vaccination NOT LIVE and therefore safe for impaired immune systems and very much recommended
HSE have a school programme
Annual screening for individuals with impaired immune systems starting at the age of 20 due to increased risk of getting the virus
Contraception
Consult your Doctor
The pill: not suitable in most liver diseases
progesterone only pill: more suitable due to no oestrogen
Depo Provera: progesterone only injection – suitable for most but avoid for active Liver Disease
Implanon: progesterone only implant – lasts 3 years – suitable for most but avoid for active Liver Disease
Intrauterine devices (eg Mierena coil/ Copper coil): suitable for those with liver disease but not with Wilsons Disease
Condoms: safe and encouraged to prevent STIs
Contraception as a subject is very important and needs to be discussed as pregnancy has serious implications for Liver Disease
Pregnancy
Before conception consult your doctor
Liver disorders are not a reason to avoid pregnancy.
Not at increased risk but implications and effects are more severe
Severe Cirrhosis and pregnancy
Inform obstetrician to carefully plan pregnancy
Difficulty conceiving
Increase risks of preterm delivery, miscarriage, stillbirth and maternal death
Risk of liver failure
Portal Hypertension and pregnancy
Increased risk of bleeding from esophageal varices
Advise endoscopy for women with cirrhosis prior to pregnancy
May consider medications
Post Liver Transplant and pregnancy
shows good outcomes
decrease risk miscarriage and increase rate of live births vs general population
most women resume normal periods within 7 months
Conception should be postponed at least 12 months after transplant due to impaired immunity
Pre conception for all Liver Disorders
Preconception counseling is advised with obstetric and liver teams
Vaccinations should be up to date
Medications and Pregnancy
Majority of meds continued with pregnancy but doses may change
CellCept (mycophenolate mofetil) is to be avoided in pregnancy
Breastfeeding on medication is OK for the most part – consult doctor
High Risk Pregnancy
Coombe has a high-risk clinic that someone will be referred to.
Closely monitor blood pressure, transplant function and baby’s growth
Aim for normal delivery on collaboration with transplant physician and neonatologist
Concluding recommendations
Get HPV vaccination
Use appropriate contraception and condoms
Link in with the Coombe before pregnancy prior pregnancy