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