Other Liver Disease
Analysis of changes in clinical characteristics and laboratory indexes of 54 cases of acute fatty liver of pregnancy
Min Zhou, Xiaodong Luo, Yang Yang
Published 2019-08-20
Cite as Chin J Hepatol, 2019, 27(8): 638-642. DOI: 10.3760/cma.j.issn.1007-3418.2019.08.010
Abstract
ObjectiveTo investigate the changes in clinical characteristics and laboratory indexes before and after the termination of pregnancy in patients with acute fatty liver of pregnancy (AFLP).
MethodsPatients with acute fatty liver of pregnancy who had been admitted to the Department of Obstetrics and Gynecology at the Second Affiliated Hospital of Chongqing Medical University and Chongqing Municipal People’s Hospital of Jiangbei District between 2007 and 2018 were selected. Clinical characteristics and complications during diagnosis and treatment, changes in blood coagulation, liver and kidney function, and postpartum recovery were collected for retrospectively analysis.
Results54 cases with average gestational age of 35.0±1.7 weeks at third trimester of pregnancy with AFLP were treated. The most common gastrointestinal symptoms were yellow urine, nausea and vomiting. All patients had elevated bilirubin. 90.7% patients had changes in blood coagulation function and 68.5% had elevated serum creatinine. Transaminase levels were dropped rapidly within 1-2 days after the termination of pregnancy. Total bilirubin recovery was slow and partially recovered after 6-8 days. Serum creatinine and BUN increased slightly after delivery, reaching a peak at 3-4 days and then began to deplete. There was slight change in prothrombin time and fibrinogen after delivery, but returned to normal level after 5-6 days. The most common complications were AKI (74.1%), LF (42.6%), PPH (40.7%) and DIC (33.3%). Twenty-three of the 54 cases (42.6%) progressed to acute liver failure. AFLP complicated with ALF course was significantly longer than healthy controls, and the disease severity was significantly increased, with a mortality rate of 17.4% (4/23), and 0 in healthy controls. The difference was statistically significant.
ConclusionEarly diagnosis and termination of pregnancy are the key factors to determine the prognosis of pregnant patients with acute fatty liver. Blood coagulation function does not deteriorate after termination of pregnancy and renal function begins to recover after 4 days with slight restoration of liver function. The control of complications is an important factor to determine the prognosis of patients.
Key words:
Acute fatty liver of pregnancy; Diagnosis; Delivery; Hemorrhage; Acute kidney injury
Contributor Information
Min Zhou
Department of Obstetrics and Gynecology, Hospital of Chongqing Red Cross Society(People's Hospital of Jiangbei District), Chongqing 400020, China
Xiaodong Luo
Obstetrics and Gynecology Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Yang Yang
Department of Obstetrics and Gynecology, Hospital of Chongqing Red Cross Society(People's Hospital of Jiangbei District), Chongqing 400020, China
