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Axelsen SM, Schmidt MC, Kampmann U, Grønbæk H, Fuglsang J. The effect of twin pregnancy in intrahepatic cholestasis of pregnancy: A case control study. Acta Obstet Gynecol Scand 2024. [PMID: 39058263 DOI: 10.1111/aogs.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/20/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Intrahepatic cholestasis of pregnancy (ICP) is one of the most common hepatic disorders during pregnancy, and the etiology is thought to be multifactorial including both environmental and hormonal contributions. In twin pregnancies, the fetal and placental mass is generally greater than in singleton pregnancies, and is, theoretically, likely to have a greater influence upon the maternal hepatic metabolism compared to singleton pregnancy. The aim of this study was to compare ICP in twin and singleton pregnancies according to ICP characteristics, time of diagnosis, serum bile acid levels, pharmacological treatment, and pregnancy outcomes. MATERIAL AND METHODS This case control study was undertaken at Aarhus University Hospital, Denmark, from 2012 to 2019. The study comprised 51 women with twin pregnancies and ICP. These women were matched with 153 women with twin pregnancies without ICP and 153 women with singleton pregnancies with ICP, respectively. Three controls were matched per case, and data obtained from medical records and Danish obstetrical databases were compared. RESULTS We found a significantly lower gestational age at ICP diagnosis in twin pregnancies (227 vs. 242 days for singleton pregnancies; p = 0.002). Bile acids reached significantly higher maximum blood levels in twin pregnancies (32.9 vs. 22.2 μmol/L; p = 0.012), and at a lower gestational age (gestational age maximum bile acids: 235 vs. 250 days; p < 0.001). No difference in pharmacological treatment was observed between the groups. Twin pregnancies with and without ICP had comparable pregnancy outcomes; however, ICP pregnancies had a higher incidence of gestational diabetes mellitus (15.7% vs. 5.2%; p = 0.03). In repeat pregnancies, ICP was diagnosed earlier in the twin pregnancy (p = 0.006). CONCLUSIONS Compared to singleton pregnancies, twin pregnant women with ICP have an earlier diagnosis of ICP, and levels of bile acids are higher. Compared to twin pregnancies without ICP, the pregnancy outcomes are comparable.
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Affiliation(s)
- Silja Maigaard Axelsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ulla Kampmann
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Grønbæk
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Abdul Waheed MI, Jaiswal A, Yelne S, Nandanwar V. Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health. Cureus 2024; 16:e58699. [PMID: 38779244 PMCID: PMC11109475 DOI: 10.7759/cureus.58699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. Despite its clinical significance, the etiology of CP, which involves genetic, hormonal, and environmental factors, remains partially understood. This comprehensive review delves into the physiology and pathophysiology of CP, outlines its clinical manifestations and diagnostic criteria, and discusses the associated maternal and fetal complications. Furthermore, it evaluates current management strategies, prognostic implications, and potential long-term effects on maternal and child health. It also explores future research directions, emphasizing the need for advancements in understanding the pathophysiology of CP, developing novel therapeutic interventions, and improving risk stratification models. By offering a thorough overview of CP, this review aims to enhance clinical awareness, guide management practices, and identify areas requiring further investigation, ultimately contributing to better health outcomes for affected women and their babies.
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Affiliation(s)
- Mohammed Irfan Abdul Waheed
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Varsha Nandanwar
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Fang ME, Peoples NA, Goulding AN, Tolcher MC. Hepatic encephalopathy precipitated by preeclampsia in the setting of cirrhosis: A case report. Case Rep Womens Health 2024; 41:e00587. [PMID: 38515998 PMCID: PMC10955193 DOI: 10.1016/j.crwh.2024.e00587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
Preeclampsia and decompensated chronic liver disease are known triggers of acute hepatic dysfunction in pregnancy, rarely including hepatic encephalopathy. Differentiating the driver of acute hepatic dysfunction in patients with concomitant preeclampsia and preexisting liver disease presents a diagnostic challenge with important management implications. A 42-year-old woman, gravida 3 para 0201, at 24 1/7 weeks of gestation presented with hepatic encephalopathy, transaminitis, and hyperbilirubinemia in the setting of cirrhosis and severe new-onset preeclampsia. The preeclampsia was thought to be the leading etiology of hepatic encephalopathy, prompting emergent Cesarean delivery at 24 2/7 weeks. Hepatic encephalopathy, blood pressure, and laboratory derangements improved promptly post-delivery. Preeclampsia can trigger acute hepatic dysfunction, including hepatic encephalopathy, in the setting of previously compensated preexisting liver disease. Recognizing this association has important implications for management and treatment.
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Affiliation(s)
- Mary E. Fang
- Baylor College of Medicine, Houston, TX 77030, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States of America
| | | | - Alison N. Goulding
- Baylor College of Medicine, Houston, TX 77030, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States of America
| | - Mary C. Tolcher
- Baylor College of Medicine, Houston, TX 77030, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States of America
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Galsone R, Vītiņa S, Jansone M, Staka A, Mohammadian R. Successful full-term pregnancy after preterm event in a liver transplant patient: a case report. J Med Case Rep 2023; 17:506. [PMID: 38071338 PMCID: PMC10710722 DOI: 10.1186/s13256-023-04189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pregnancy after liver transplantation poses a significant challenge to both the patient and the transplant team. CASE PRESENTATION We present the case of a 19-year-old European patient who underwent liver transplantation 5 years previously owing to autoimmune hepatitis. Poor compliance with immunosuppressive therapy and missed follow-up visits during the patient's first pregnancy likely contributed to her liver function deterioration, hospitalization, and failed pregnancy. Owing to the patient's complex medical history, combined immunosuppressive treatment, and risks to the fetus, her second pregnancy was high risk. However, close outpatient monitoring and adherence to treatment led to a successful, uneventful, full-term pregnancy and healthy delivery. CONCLUSION Liver transplant recipients who desire to become pregnant require careful planning and management to ensure optimal outcomes for both the mother and the fetus. A personalized strategy is necessary to balance the potential benefits of childbirth with the risks involved in pregnancy after liver transplantation.
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Affiliation(s)
- Ramona Galsone
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Sandra Vītiņa
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Maira Jansone
- Women and child health clinic, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu street 13, Riga, 1002, Latvia
| | - Aiga Staka
- Gastroenterology, Hepatology and Nutrition Therapy Center, Pauls Stradins Clinical University Hospital, Pilsonu street 13, Riga, 1002, Latvia
| | - Reza Mohammadian
- Radiology Department, Riga East University Clinical Hospital, Stradins University, Hippocrates Street 2, Riga, 1038, Latvia.
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Brügge M, Pecks U, Iannaccone A, Palz-Fleige M, Stepan H, Tauscher A. [Acute Fatty Liver of Pregnancy - Case Series]. Z Geburtshilfe Neonatol 2023; 227:466-473. [PMID: 37490932 DOI: 10.1055/a-2096-6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
With a prevalence of 0,01-0,03%, acute fatty liver in pregnancy (AFLP) is a rare and dangerous complication of pregnancy and is difficult to distinguish from other, sometimes more common, pregnancy diseases such as HELLP syndrome, aHUS and TTP because of its mostly non-specific symptoms. Due to its rarity, AFLP is often not obvious to the obstetrician as a possible differential diagnosis. Yet early diagnosis and the fastest possible delivery is the only causal therapy and is important for the mortality rate. In the present manuscript, the pathophysiology, diagnosis and therapy of acute fatty liver in pregnancy are highlighted for the clinical routine based on case descriptions from three university hospitals, and reference is made to possible findings that are helpful in establishing the diagnosis. The angiogenic preeclampsia marker sFlt-1 plays a role and provides new opportunities to consider pathophysiological approaches.
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Affiliation(s)
- Martina Brügge
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
| | - Monika Palz-Fleige
- Klinik für Gynäkologie und Geburtshilfe, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Holger Stepan
- Geburtsmedizin, Universitätsfrauenklinik Leipzig, Leipzig, Germany
| | - Anne Tauscher
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
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Vento S, Cainelli F. Acute liver failure in low-income and middle-income countries. Lancet Gastroenterol Hepatol 2023; 8:1035-1045. [PMID: 37837969 DOI: 10.1016/s2468-1253(23)00142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 10/16/2023]
Abstract
Acute liver failure is a rare condition involving the rapid development, progression, and worsening of liver dysfunction, characterised by coagulopathy and encephalopathy, and has a high mortality unless liver transplantation is performed. Population-based studies are scarce, and most published data are from high-income countries, where the main cause of acute liver failure is paracetamol overdose. This Review provides an overview of the scanty literature on acute liver failure in low-income and middle-income countries, where patients are often admitted to primary care hospitals and viral hepatitis (especially hepatitis E), tropical infections (eg, dengue), traditional medicines, and drugs (especially anti-tuberculosis drugs) have an important role. We discuss incidence, cause, occurrence in children and pregnant women, prognostic factors and scores, treatment, and mortality. To conclude, we advocate for international collaboration, the establishment of central registries for the condition, and better diagnostics.
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Affiliation(s)
- Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia.
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Lu W, Hu MJ, Zhu DD, Lin FJ, Huang HD. Clinical characteristics and prognosis of pregnancy-related acute kidney injury: a case series study. Int Urol Nephrol 2023; 55:2249-2255. [PMID: 36853447 DOI: 10.1007/s11255-023-03484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) seriously affects the health of both pregnant women and fetuses. This study aimed to investigate the clinical characteristics and prognosis of pregnancy-related AKI (PR-AKI). METHODS This case series study enrolled pregnant women with PR-AKI admitted to the surgical intensive care unit of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2010 and December 2020. RESULTS Thirty-one PR-AKI patients were enrolled with a mean age of 29.16 ± 4.97 years. Seventeen pregnant women (54.84%) had complete recovery of renal function, 5 (16.13%) had partial recovery of renal function, 2 (6.45%) patients had no renal function improvement, and 7 (22.58%) died. Among the 31 patients with 35 fetuses, 25 (80.6%) pregnant women had poor fetal outcomes, including 5 cases of stillbirths, 5 neonatal asphyxia, 18 premature births, 10 low birth weight, and 8 deficient birth weight infants. Compared to cases with good fetal outcomes, cases with poor fetal outcomes had significantly shorter gestational weeks (39.26 ± 1.53 vs. 31.62 ± 5.50, P = 0.002), lower platelet count (217.13 ± 122.87 vs. 90.24 ± 84.88, P = 0.005), lower hemoglobin (94.19 ± 13.21 vs. 74.48 ± 20.78, P = 0.036), higher blood urea nitrogen (11.87 ± 4.28 vs. 19.47 ± 10.98, P = 0.013), and higher uric acid (262.41 ± 167.00 vs. 586.87 ± 144.52, P < 0.001). CONCLUSIONS The maternal renal function of women with PR-AKI might improve after treatment, but occurrence rates of adverse fetal outcomes were still high.
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Affiliation(s)
- Wei Lu
- Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
| | - Min-Jie Hu
- Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Dong-Dong Zhu
- Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Fu-Jun Lin
- Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Hai-Dong Huang
- Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
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Asantewaa G, Anabire NG, Bauer M, Weis S, Neugebauer S, Quaye O, Helegbe GK. Serum Metabolome Signatures Characterizing Co-Infection of Plasmodium falciparum and HBV in Pregnant Women. Diseases 2023; 11:94. [PMID: 37489446 PMCID: PMC10366841 DOI: 10.3390/diseases11030094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023] Open
Abstract
Plasmodium falciparum (P. falciparum) and hepatitis B virus (HBV) co-infection is on the rise among pregnant women in northern Ghana. Mono-infection with either of these two pathogens results in unique metabolic alterations. Thus, we aimed to explicate the effects of this co-infection on the metabolome signatures of pregnant women, which would indicate the impacted metabolic pathways and provide useful prognostic or diagnostic markers. Using an MS/MS-based targeted metabolomic approach, we determined the serum metabolome in pregnant women with P. falciparum mono-infection, HBV mono-infection, P. falciparum, and HBV co-infection and in uninfected (control) women. We observed significantly decreased sphingolipid concentrations in subjects with P. falciparum mono-infection, whereas amino acids and phospholipids were decreased in subjects with HBV mono-infection. Co-infections were found to be characterized distinctively by reduced concentrations of phospholipids and hexoses (mostly glucose) as well as altered pathways that contribute to redox homeostasis. Overall, PC ae C40:1 was found to be a good discriminatory metabolite for the co-infection group. PC ae C40:1 can further be explored for use in the diagnosis and treatment of malaria and chronic hepatitis B co-morbidity as well as to distinguish co-infections from cases of mono-infections.
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Affiliation(s)
- Gloria Asantewaa
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Accra P.O. Box LG54, Ghana; (G.A.); (N.G.A.); (O.Q.)
| | - Nsoh Godwin Anabire
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Accra P.O. Box LG54, Ghana; (G.A.); (N.G.A.); (O.Q.)
- Department of Biochemistry & Molecular Biology, School of Medicine, University for Development Studies, Tamale P.O. Box TL1350, Ghana
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (M.B.); (S.W.)
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany
| | - Sebastian Weis
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (M.B.); (S.W.)
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany
- Institute for Infectious Disease and Infection Control, Leibniz Institute for Infection Biology and Natural Product Research, Hans-Knöll Institute (HKI), 07745 Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute (HKI), 07745 Jena, Germany
| | - Sophie Neugebauer
- Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, 07747 Jena, Germany;
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Accra P.O. Box LG54, Ghana; (G.A.); (N.G.A.); (O.Q.)
| | - Gideon Kofi Helegbe
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell & Molecular Biology, University of Ghana, Accra P.O. Box LG54, Ghana; (G.A.); (N.G.A.); (O.Q.)
- Department of Biochemistry & Molecular Biology, School of Medicine, University for Development Studies, Tamale P.O. Box TL1350, Ghana
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Sinha S, Yadav J, Pradhan T. A Case Report on Acute Fatty Liver of Pregnancy: A Difficult Differential Diagnosis of Liver Disorder. Cureus 2023; 15:e42733. [PMID: 37654930 PMCID: PMC10467326 DOI: 10.7759/cureus.42733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/02/2023] Open
Abstract
Acute fatty liver of pregnancy is a rare but potentially dangerous pregnancy condition with significant maternal and fetal fatality rates. The disorder is driven by a complex pathophysiology and clinically manifests as a rapid worsening in health conditions, increasing the rate of mortality and necessitating expert diagnosis and management. The condition progresses from spontaneous resolution to post-operative complications, resulting in negative consequences. We offer a case report of a young primigravida patient diagnosed with acute fatty liver of pregnancy at term. The report describes the clinical course and its effect. The perinatal result, however, could not be improved due to the late diagnosis. Over the last 40 years, death rates have been dramatically lowered because of competence and a multidisciplinary approach, increasing maternal-fetal outcomes. In this scenario, time management is crucial to success.
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Affiliation(s)
- Shivangni Sinha
- Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, IND
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Jyotsna Yadav
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Tarun Pradhan
- Obstetrics and Gynecology, Birat Medical College and Teaching Hospital, Dharan, NPL
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Karim G, Giri D, Kushner T, Reau N. Evaluation of Liver Disease in Pregnancy. Clin Liver Dis 2023; 27:133-155. [PMID: 36400462 DOI: 10.1016/j.cld.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver disease in pregnancy often requires diagnostic and therapeutic considerations that are unique to pregnancy. Liver disease in pregnancy is commonly thought of as either liver disease unique to pregnancy, chronic liver disease, or liver disease coincidental to pregnancy. This review summarizes the approach to evaluation of liver disease in pregnancy.
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Affiliation(s)
- Gres Karim
- Department of Medicine, Mount Sinai Beth Israel, 350 East 17th Street, 20th Floor, New York, NY 10003, USA
| | - Dewan Giri
- Department of Medicine, Mount Sinai Beth Israel, 350 East 17th Street, 20th Floor, New York, NY 10003, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10023, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10023, USA.
| | - Nancy Reau
- Division of Hepatology, Rush University Medical Center, 1725 West Harrison Street
- Suite 319, Chicago, IL 60612, USA
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Valdovinos-Bello V, García-Romero CS, Cervantes-Peredo A, García-Gómez E, Martínez-Ibarra A, Vázquez-Martínez ER, Valdespino Y, Cerbón M. Body mass index implications in intrahepatic cholestasis of pregnancy and placental histopathological alterations. Ann Hepatol 2023; 28:100879. [PMID: 36436771 DOI: 10.1016/j.aohep.2022.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Intrahepatic cholestasis is a frequent disease during pregnancy. It is unknown if liver function alterations produce specific placental lesions. The aim of this study was to evaluate placental histopathological changes in patients with intrahepatic cholestasis of pregnancy (ICP), and to explore correlations between the placental histopathology and hepatic function alteration or patient comorbidities, and body mass index. PATIENTS AND METHODS A retrospective cohort study included women with ICP, most of them showing comorbidities such as overweight/obesity, preeclampsia and gestational diabetes. They were attended at the National Institute of Perinatology in Mexico City for three years. Placental histopathological alterations were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. Data was analyzed using Graph-Pad Prism 5. RESULTS The results indicated that the placenta of ICP patients showed many histopathological alterations; however, no correlations were observed between the increase in bile acids or liver functional parameters and specific placental lesions. The most frequent comorbidities found in ICP patients were obesity, overweight and preeclampsia. Surprisingly, high percentage of ICP patients did not respond to UDCA treatment independently of the BMI group to which they belonged. CONCLUSION The data suggest that ICP contribute to placental lesions. In addition, in patients with normal weight, an increase of chorangiosis and a reduced accelerated villous maturation without syncytial knots were observed in comparison with overweight and obese patients. It is necessary to improve the medical strategies in the treatment and liver disfunction surveillance of ICP patients.
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Affiliation(s)
- Violeta Valdovinos-Bello
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), 04510, CDMX, México
| | - Carmen Selene García-Romero
- Departamento de Infectología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, 11000, CDMX, México
| | - Alicia Cervantes-Peredo
- Servicio de Genética, Hospital General de México Dr. Eduardo Liceaga/Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, México
| | - Elizabeth García-Gómez
- CONACyT-Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), 04510, CDMX, México
| | - Alejandra Martínez-Ibarra
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), 04510, CDMX, México
| | - Edgar Ricardo Vázquez-Martínez
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), 04510, CDMX, México
| | - Yolotzin Valdespino
- Departamento de Patología, Instituto Nacional de Perinatología, 11000, CDMX, México.
| | - Marco Cerbón
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), 04510, CDMX, México.
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Assessment of Clinical Characteristics and Outcomes of Liver Diseases Unique to Pregnancy at a Tertiary Hospital in Ethiopia: A Retrospective Cohort Study. Int J Hepatol 2022; 2022:9894407. [PMID: 36578273 PMCID: PMC9792252 DOI: 10.1155/2022/9894407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Liver disease is a rare complication of pregnancy that can lead to several consequences and require specific intervention with implications for both the mother and fetus. This study is aimed at assessing the clinical profile and associated complications of liver diseases unique to pregnancy at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methodology. This study is a retrospective cohort study of all identified cases admitted to the obstetrics ward and intensive care unit (ICU) from January 2018 to December 2020 at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Medical records were reviewed for clinical features, biochemical profiles, and fetomaternal complications. Data were analyzed using SPSS version 26. A chi-square test was done to look for an association with a p value less than 0.05 considered statistically significant, and an odds ratio was determined to assess the effect size. RESULTS From 95 cases identified, preeclampsia/eclampsia with liver dysfunction accounted for 43 (45%), followed by hemolysis elevated liver enzyme and low platelet (HELLP syndrome) 35 (36.8%), hyperemesis gravidarum with liver dysfunction 9 (9.5%), acute fatty liver of pregnancy (AFLP) 7 (7.4%), and intrahepatic cholestasis of pregnancy 1 (1.1%). When compared to HELLP syndrome, AFLP showed significantly higher median (IQR) values (p < 0.05) for total bilirubin 13.3 (7.3-16.3), direct bilirubin 9.73 (6.87-11.9) mg/dL, prothrombin time 23 (20.4-25.7) seconds, international normalization ratio 2.2 (1.9-2.4), white blood count 23.8 (17.8-26.6)∗103/μL, creatinine 3.5 (2.44-5.6) mg/dL, and lower hemoglobin level of 7.9 (6.2-10) g/dL. There were 4 (4.2%) maternal hospital deaths, with a case fatality rate of HELLP syndrome being 8.6% and 14.3% in AFLP. The overall hospital fetal mortality was 33 (34.7%). In this study, 42 patients with HELLP syndrome and AFLP had an increased risk of maternal ICU admission (OR = 25.5, 95% CI: 5.48-118.6, p value = 0.001), acute kidney injury requiring dialysis (OR = 12.2, 95% CI: 1.46-102.2, p value = 0.009), placental abruption (OR = 14.2, 95% CI: 1.72-117.1, p value = 0.004), and stillbirth (OR = 7.2, 95% CI: 2.38-21.7, p value = 0.001). CONCLUSION Preeclampsia with liver dysfunction and HELLP syndrome accounted for the majority of cases. It also demonstrated key biochemical characteristics that can be used to distinguish between HELLP syndrome and AFLP. Emphasis has to be given to the risk of requiring maternal ICU admission, dialysis, abruption of the placenta, and stillbirths while managing patients diagnosed with HELLP syndrome and AFLP.
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Kushner T, Park C, Masand D, Rosenbluth E, Carroll C, Grace M, Rodriguez-Rivas C, De La Cruz H, Overbey J, Sperling R. Prevalence of elevated alanine aminotransferase (ALT) in pregnancy: A cross-sectional labor and delivery-based assessment. Medicine (Baltimore) 2022; 101:e30408. [PMID: 36221350 PMCID: PMC9542988 DOI: 10.1097/md.0000000000030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since liver tests are not routinely checked in pregnancy, the prevalence of abnormal liver tests and liver-related abnormalities in pregnancy in a US-based population is not known. We sought to determine the prevalence of abnormal alanine aminotransferase (ALT) among pregnant Individuals who present to labor and delivery for evaluation and to evaluate prevalence of underlying diagnosed liver conditions. Prospective study evaluating liver tests in consecutive samples obtained on the labor and delivery unit. Patient characteristics were compared between those with and without abnormal ALT and those with and without abnormal ALT without a liver-related diagnosis made in clinical practice, using t tests for continuous measures and χ2 or Fisher's exact tests as appropriate for categorical measures. Logistic regression was utilized to identify factors associated with abnormal ALT in this subcohort to determine predictors of abnormal ALT in those without a known liver-related diagnosis. We collected 1024 laboratory specimens from 996 patients. Of these patients, 131 of 996 (13.2%) had elevated ALT ≥25 IU/L; 20 (2%) had ALT ≥50, 6 (0.6%) had ALT ≥125 and 3 (0.3%) had ALT ≥250. 61/131 (46.6%) of patients with ALT ≥25 IU/L had not had LTs checked during routine pregnancy care. 20 (15%) of individuals with abnormal LT had preeclampsia; 5 (4%) had cholestasis of pregnancy; 1 (0.8%) had hepatitis C; there were no other chronic liver diseases diagnosed. There were no significant demographic or clinical differences between those with and without ALT ≥25, whether liver disease diagnosis was made or not. We identified an over 10% prevalence of abnormal LTs in consecutive pregnant individuals who presented to L&D, most of whom did not have a liver-related condition diagnosed in clinical practice. Among those with liver-related diagnoses, PE and ICP were the most common among individuals with ALT≥25 IU/mL, with chronic liver disease rarely diagnosed. Further evaluation of the role of ALT testing as part of routine prenatal care is needed, particularly in establishing a baseline prevalence of liver test abnormalities in pregnancy and independent association with pregnancy outcomes.
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
- * Correspondence: Tatyana Kushner, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10029 (e-mail: )
| | - Claire Park
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dana Masand
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Rosenbluth
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carin Carroll
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marie Grace
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clara Rodriguez-Rivas
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hernis De La Cruz
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jessica Overbey
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Zhou N, Zhang F, Kuriakose C, Gordon D, Parikh A. A Case of Transient Gestational Hyperthyroidism Complicated With Acute Liver Injury Successfully Treated With Plasma Exchange. Cureus 2022; 14:e29442. [PMID: 36299942 PMCID: PMC9587679 DOI: 10.7759/cureus.29442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/21/2022] Open
Abstract
Therapeutic Plasma Exchange (TPE) in pregnancy is rare due to the uncertainty of efficiency and safety in clinical practice. It is experience-based on extrapolation of efficacy and safety in non-pregnant populations than evidence-based. We reported a case of severe refractory hyperemesis gravidarum secondary to transient gestational hyperthyroidism in a first-trimester pregnancy, which was complicated by acute hepatic injury during the clinical course and successfully managed with TPE. Both the clinical picture and objective index were improved dramatically after plasma exchanges. Three sessions of plasma exchange provided a 61% decrease in serum FT4 (free thyroxine) concentration (4.34 ng/dL to 1.71 ng/dL) and 89% decrease in alanine aminotransferase (ALT) (647 units/L to 69 units/L). The patient's symptoms improved significantly after TPE. In two weeks follow-up visit, her thyroid function was in the recommended range of 1st-trimester pregnancy (1.06 ng/dL) and her liver function was normalized (ALT 15 units/L, aspartate aminotransferase {AST} 11 units/L). In conclusion, plasma exchange may be used as an alternative therapeutic option in pregnancy to manage transient hyperthyroidism who failed or was unable to tolerate or have contradictions to antithyroid medications and thyroidectomy. Our case provides evidence of TPE in the treatment of thyrotoxicosis in pregnancy.
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15
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Nadeev AP, Madonov PG, Porotnikova EV, Koshlich KA, Kuznetsov AV, Ovsyanko EV, Kostina LY, Yakuba DY. Postpartum Involution of Mouse Myometrium in Acute CCl4-Induced Hepatosis and Its Correction with Immobilized Hyaluronidase. Bull Exp Biol Med 2022; 173:265-269. [DOI: 10.1007/s10517-022-05531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 11/29/2022]
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Elshaarawy O, Abdelaziz R, Zayed N, Hany A, Hammam Z, Mueller S, Yosry A, Shousha HI. Acoustic radiation force impulse to measure liver stiffness and predict hepatic decompensation in pregnancy with cirrhosis: A cohort study. Arab J Gastroenterol 2022; 23:89-94. [DOI: 10.1016/j.ajg.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 02/07/2023]
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17
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Varlas VN, Bohîlțea R, Gheorghe G, Bostan G, Angelescu GA, Penes ON, Bors RG, Cloțea E, Bacalbasa N, Diaconu CC. State of the Art in Hepatic Dysfunction in Pregnancy. Healthcare (Basel) 2021; 9:1481. [PMID: 34828527 PMCID: PMC8618725 DOI: 10.3390/healthcare9111481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
Hepatic dysfunction in pregnant women is always challenging for the obstetrician, as the spectrum of hepatic abnormalities can be very large and have various implications, both for mother and fetus. There is a diagnostic and therapeutic polymorphism of hepatic dysfunction in pregnancy and insufficient knowledge related to the etiopathogenesis and epidemiology of this disease. The clinical forms of hepatic dysfunction encountered in pregnancy can vary from liver diseases related to pregnancy (e.g., HELLP syndrome, intrahepatic cholestasis, hyperemesis gravidarum, or acute fatty liver of pregnancy) to de novo ones occurring in pregnancy, and pre-existing liver disease (cholelithiasis, Budd-Chiari syndrome, and cirrhosis). We performed a systematic literature search over 10 years. The review protocol assumed a search of two databases (PubMed®/MEDLINE and Web of Science Core Collection). The strategy regarding the management of these diseases involves multidisciplinary teams composed of different specialists (obstetricians, gastroenterologists and anesthetists) from specialized tertiary centers. Despite the improving prognosis of pregnant women with liver diseases, the risk of maternal-fetal complications remains very high. Therefore, it is necessary to ensure careful monitoring by a multidisciplinary team and to inform the patients of the potential risks.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Roxana Bohîlțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Gina Gheorghe
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Georgiana Bostan
- Department of Obstetrics and Gynecology, County Emergency Hospital “St. John the New”, 720034 Suceava, Romania;
| | - Gabriela Anca Angelescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Internal Medicine, County Emergency Hospital Ilfov, 022115 Bucharest, Romania
| | - Ovidiu Nicolae Penes
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Anesthesiology and Intensive Care, University Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Eliza Cloțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Nicolae Bacalbasa
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Visceral Surgery, “Fundeni” Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Abstract
Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with pre-existing disease, pre-pregnancy counselling is important to discuss the potential complications that may occur during pregnancy and how best to manage these. Acute fatty liver of pregnancy and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome are pregnancy-related liver diseases and are considered obstetric emergencies. Women with liver dysfunction need appropriate investigations, including blood tests and imaging. They should be managed as part of a multidisciplinary team with obstetricians, obstetric anaesthetists, specialist midwives, gastroenterologists and obstetric physicians.
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Affiliation(s)
- Elvyna Lim
- Luton and Dunstable University Hospital, Luton, UK.,joint first authors
| | - Maria Mouyis
- Luton and Dunstable University Hospital, Luton, UK .,joint first authors
| | - Lucy MacKillop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK and honorary senior clinical lecturer, University of Oxford, Oxford, UK
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19
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Axelsen SM, Kampmann U, Koefoed AS, McIntyre D, Ovesen PG, Fuglsang J. Intrahepatic cholestasis of pregnancy: Association with glycaemic control in gestational diabetes. Diabet Med 2021; 38:e14574. [PMID: 33786869 DOI: 10.1111/dme.14574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 12/31/2022]
Abstract
AIMS The aim of this study was to determine whether the metabolic glucose profile, based on glycaemic control and insulin requirements, was different in women with gestational diabetes mellitus (GDM) and intrahepatic cholestasis of pregnancy (ICP) compared to women with only GDM. METHODS This retrospective cohort study comprised women with GDM and ICP matched with women with only GDM was undertaken at Aarhus University hospital, Denmark, from 2012 to 2019. A total of 46 cases and 184 controls were compared in relation to glycaemic control during pregnancy. Women with GDM and ICP were further divided into subgroups according to the severity of ICP: mild ICP (fasting bile salts 10-39 μmol/L) and moderate/severe ICP (bile salts ≥40 μmol/L). RESULTS No statistically significant differences were observed in baseline 2-h oral glucose tolerance test values, second and third trimester HbA1c values, or maximum insulin requirements during pregnancy between women with GDM with and without ICP. Significantly more women with ICP developed preeclampsia during pregnancy: 23.9% (11/46) versus 7.6% (14/184); p = 0.003. CONCLUSIONS This study is the first to address the course of pregnancy in women with GDM with and without ICP in a clinical setting. Under the current treatment guidelines, ICP is not associated with clinically significant changes in glycaemic control in GDM. Significantly more women with both GDM and ICP developed preeclampsia.
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Affiliation(s)
- Silja M Axelsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Ulla Kampmann
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Anna S Koefoed
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - David McIntyre
- Mater Research, The University of Queensland, South Brisbane, Qld, Australia
| | - Per G Ovesen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
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Gad El-Hak HN, Abdelrazek HMA, Zeidan DW, Almallah AA, Khaled HE. Assessment of changes in the liver of pregnant female rats and their fetuses following monosodium glutamate administration. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:44432-44441. [PMID: 33847887 DOI: 10.1007/s11356-021-13557-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
Monosodium glutamate (MSG) is a common flavor enhancer and stabilizer for ready-made or packaged foods. This research investigated the impact of MSG on the maternal and fetal liver. The present study was carried out on sixteen mature female Albino rats and eight male rats of reproductive age. The control group was dissected on day 20 of gestation. MSG group was administrated MSG daily at a dosage of 1 g/5 mL/kg body weight from day 0 to day 20 of gestation. The liver function and lipid profile of the control and treated mothers were investigated in the blood sera. The levels of nitric oxide (NO), tumor necrosis factor (TNF-α), superoxide dismutase (SOD), and reduced glutathione (GSH) activities in the liver homogenate of maternal and fetal tissue were assayed, in addition to histopathological, histochemical and immunohistochemical studies were done to the liver tissue. The activities of liver functions and lipid profile significantly altered in the treated mothers with MSG. MSG significantly reduced the SOD and reduced GSH activities in addition to the elevated TNF-α and NO in liver tissue of pregnant mothers and their fetuses. Severe histopathological alterations were observed in both maternal and fetal liver tissues of MSG-treated groups. Moreover, histochemical observations showed a reduction of total polysaccharides in the liver of pregnant rats and fetuses. A significant increase in the percentage area of positive immunoreaction for caspase 3 was observed in the liver of treated rats with MSG compared to the liver of the control. The liver of fetuses treated with MSG revealed an alteration like their mother. This study showed that during the gestational period MSG exposure resulted in several biochemical, histological, and histochemical changes in the maternal and fetal liver tissues which emphasize the toxic effect of MSG.
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Affiliation(s)
- Heba N Gad El-Hak
- Zoology Department, Faculty of Sciences, Suez Canal University, Ismailia, Egypt.
| | - Heba M A Abdelrazek
- Department of Physiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Dalia W Zeidan
- Department of Home and Economics, Nutrition and Food Science Branch, Faculty of Education, Suez Canal University, Ismailia, Egypt
| | - Amani A Almallah
- Department of Anatomy and Embryology, Faculty of Medicine, Suez University, Ismailia, Egypt
| | - Howayda E Khaled
- Zoology Department, Faculty of Sciences, Suez University, Ismailia, Egypt
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Sirilert S, Tongsong T. Hepatitis B Virus Infection in Pregnancy: Immunological Response, Natural Course and Pregnancy Outcomes. J Clin Med 2021; 10:jcm10132926. [PMID: 34210105 PMCID: PMC8267880 DOI: 10.3390/jcm10132926] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/02/2023] Open
Abstract
This review aimed to provide an update on the impact of pregnancy on the natural course of hepatitis B virus (HBV) infection and also on the impact of HBV infection on adverse pregnancy outcomes, including mother-to-child transmission (MTCT). For the literature review, original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The databases of PubMed, EMBASE, and CINAHL were carefully searched for articles in English on topics related to HBV infection, pregnancy, and vertical transmission from 1960 to May 2021. Immunological changes during pregnancy such as suppression of Th1 response and induction of Th2 immunity lead to an impaired immune reaction to HBV and stimulate viral activity along with the reduction of CD8 T cells to escape immune detection. The impact of pregnancy on the natural course of chronic HBV infection seems to be minimal, while pregnancy can increase morbidity and mortality in the case of advanced HBV hepatitis or cirrhosis. Importantly, hepatitis flare or alanine aminotransferase (ALT) flare can occur during pregnancy and is more common during the postpartum period due to the interaction between HBV and the immune response. Interestingly, the impact of HBV infection on adverse pregnancy outcomes is more serious than ever thought. Updated evidence indicates that pregnancies with chronic HBV infection increase the risk of preterm birth and gestational diabetes, especially in cases of positive hepatitis e antigen (HBeAg).
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22
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Wilson RD. Guideline No. 409: Intrauterine Fetal Diagnostic Testing in Women with Chronic Viral Infections. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1555-1562.e1. [PMID: 33308791 DOI: 10.1016/j.jogc.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This revised guideline provides updated information for the care of women with chronic viral infections who require intrauterine fetal diagnostic testing. TARGET POPULATION Women with chronic viral infections who are pregnant or planning a pregnancy. OPTIONS Non-invasive screening tests for diagnosis: maternal serum placental analytes with or without nuchal translucency, sonography, maternal serum cell-free placental DNA; and intrauterine fetal diagnostic testing: amniocentesis, chorionic villus sampling, cordocentesis. OUTCOMES The recommendations in this guideline have the potential to decrease or eliminate morbidity and mortality in women with chronic viral infections and their infants, which is associated with significant health and economic outcomes. EVIDENCE Published literature was retrieved through searches of PubMed, guidelines of national societies (Society of Obstetricians and Gynaecologists of Canada, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, other international societies), and the Cochrane Library using appropriate controlled vocabulary (amniocentesis, chorionic villus sampling, cordocentesis, procedure pregnancy loss risk, viral vertical transmission, fetal and neonatal infection) and keywords (maternal infection or exposure, hepatitis B, hepatitis C, human immunodeficiency virus). Results were restricted to systematic reviews, randomized controlled trials or controlled clinical trials (if available), and observational case-control studies or case series from 2012 to 2019 published in English or French. Studies from 1966 to 2002 were previously reviewed in the SOGC guideline No. 123: Amniocentesis and Women with Hepatitis B, Hepatitis C, or Human Immunodeficiency Virus, and those from 2002 to 2012 were previously reviewed in the SOGC guideline No. 309: Prenatal Invasive Procedures in Women With Hepatitis B, Hepatitis C, and/or Human Immunodeficiency Virus Infections. Updated literature searches were completed regularly through August 2019 and were incorporated into this guideline. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE The intended users are maternity care providers and women with chronic viral infections. This guideline provides information to educate and counsel these women, and to offer them reproductive options. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Gunay E, Kaya S, Kavak S, Ocal E, Tunc N. Successful treatment of azathioprine-related cholestasis in a pregnant woman who received a kidney transplant. J OBSTET GYNAECOL 2021; 42:166-168. [PMID: 34018456 DOI: 10.1080/01443615.2021.1904226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emrah Gunay
- Department of Nephrology, Gazi Yasargil Training and Research Hospital, University of Health Sciences of Turkey, Diyarbakir, Turkey
| | - Safak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences of Turkey, Diyarbakir, Turkey
| | - Seyhmus Kavak
- Department of Radiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences of Turkey, Diyarbakir, Turkey
| | - Ece Ocal
- Department of Perinatology, Gazi Yasargil Training and Research Hospital, University of Health Sciences of Turkey, Diyarbakir, Turkey
| | - Nurettin Tunc
- Department of Gastroenterology, Gazi Yasargil Training and Research Hospital, University of Health Sciences of Turkey, Diyarbakir, Turkey
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Loskutova I, Bichevskaya R. DISORDER OF INNATE IMMUNITY AND THE SEVERITY OF IMMUNOCOMPLEX REACTIONS IN PREGNANT WOMEN WITH MISCARRIAGE AGAINST THE BACKGROUND OF EXTRAGENITAL PATHOLOGY. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm2021-1-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The functional activity of monocytes and the concentration of circulating immune complexes in the blood of pregnant women with chronic liver disease and early reproductive losses were studied. In pregnant women in the first trimester of gestation with an unfavorable premorbid background, a decrease in the phagocytic activity of monocytes was revealed, which indicates a decrease in the functional ability of the macrophages of the future mother. Along with the lack of nonspecific resistance of the body, the examined patients showed an increase in circulating immune complexes due to pathogenic medium-molecular fractions. The lowest indicators of monocyte phagocytic activity and a significant increase in the concentration of circulating immune complexes were found in patients with exacerbation of non-alcoholic steatohepatitis, which could provoke premature termination of pregnancy in the first trimester.
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25
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Wilson RD. Directive clinique n o 409 : Tests diagnostiques fœtaux intra-utérins en cas d'infection virale chronique maternelle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1563-1570.e1. [PMID: 33308792 DOI: 10.1016/j.jogc.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIF La présente directive clinique révisée met à jour les renseignements sur la prestation de soins aux femmes atteintes d'une infection virale chronique devant se soumettre à un test diagnostique fœtal intra-utérin. POPULATION CIBLE Femmes atteintes d'une infection virale chronique qui sont enceintes ou prévoient le devenir. OPTIONS Tests de dépistage non invasifs à des fins diagnostiques : marqueurs placentaires sériques maternels avec ou sans mesure de la clarté nucale, échographie, ADN fœtal libre circulant dans le sang maternel; et tests diagnostiques fœtaux intra-utérins : amniocentèse, biopsie choriale (choriocentèse), cordocentèse. ISSUES Les recommandations de la présente directive clinique pourraient réduire ou éliminer la morbi-mortalité chez les femmes atteintes d'une infection virale chronique et leurs nourrissons, ce qui est associé à d'importantes conséquences sur les plans de la santé et de l'économie. DONNéES PROBANTES: La littérature publiée a été recueillie au moyen de recherches dans les bases de données PubMed et Cochrane Library ainsi que dans les directives cliniques de sociétés médicales nationales et internationales (Société des obstétriciens et gynécologues du Canada, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine et d'autres sociétés internationales) en utilisant un vocabulaire (amniocentesis, chorionic villus sampling, cordocentesis, procedure pregnancy loss risk, viral vertical transmission, fetal and neonatal infection) et des mots clés (maternal infection or exposure, hepatitis B, hepatitis C, human immunodeficiency virus) contrôlés et appropriés. Les résultats retenus se limitent aux revues systématiques, aux essais cliniques randomisés ou aux essais cliniques comparatifs (si disponibles) et aux études cas-témoins observationnelles ou études de série de cas publiées entre 2012 et 2019 en anglais ou en français. Les études publiées entre 1966 et 2002 ont déjà été examinées dans la directive clinique de la SOGC no 123, L'amniocentèse chez les femmes infectées par l'hépatite B, l'hépatite C ou le virus de l'immunodéficience humaine; les études publiées entre 2002 et 2012 ont quant à elles été examinées dans la directive clinique de la SOGC no 309, Interventions effractives prénatales chez les femmes qui présentent des infections par le virus de l'hépatite B, le virus de l'hépatite C et/ou le virus de l'immunodéficience humaine. De nouvelles recherches ont été effectuées dans la littérature jusqu'en août 2019, puis ont été intégrées à la présente directive clinique. MéTHODES DE VALIDATION: L'auteur a évalué la qualité des données probantes et la solidité des recommandations au moyen du cadre méthodologique GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Consulter l'annexe A en ligne (le tableau A1 pour les définitions et le tableau A2 pour les interprétations des recommandations fortes et faibles). PUBLIC VISé: Les utilisateurs prévus sont des fournisseurs de soins de maternité et les femmes atteintes d'une infection virale chronique. Cette directive fournit des renseignements pour renseigner et conseiller ces femmes et leur offrir des options de procréation. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Huang X, Chen S, Chen H, Hu L, Wen L, Wei F, Chen K. ROC Curve Analysis of the Sensitivity and Specificity of Biochemical Detection of Intrahepatic Cholestasis during Pregnancy. Z Geburtshilfe Neonatol 2020; 225:327-332. [PMID: 33246351 DOI: 10.1055/a-1299-2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse pregnancy outcomes in mothers and infants. The aim was to evaluate the sensitivity and specificity of biochemical detection of ICP by ROC curve and to determine the threshold of more reliable experimental indicators. MATERIALS AND METHODS 305 patients and 305 healthy pregnant women were enrolled in the study. RESULTS The average levels of TBA, ALT, and AST in the ICP group were much higher than those in the control group (P<0. 001); the area of both CG and TBA under ROC curve was up to 0.99, the sensitivity was 97.7%, and the specificity was 99.3%. CONCLUSIONS This study did not find any single specificity and sensitivity markers that could be used to reliably diagnose ICP. In the future, we will pay more attention to the correlation between sensitive biochemical indicators and adverse pregnancy outcomes.
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Affiliation(s)
- Xiaoyi Huang
- Guangdong Pharmaceutical University, School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangzhou, China
| | - Siyi Chen
- Guangdong Pharmaceutical University, School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangzhou, China
| | - Hongyan Chen
- Guangdong Pharmaceutical University, School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangzhou, China
| | - Liang Hu
- Shenzhen Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Lijuan Wen
- Shenzhen Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Fengxiang Wei
- Shenzhen Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Ken Chen
- Guangdong Pharmaceutical University, School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangzhou, China
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Maternal and neonatal outcomes and prognostic factors in acute fatty liver of pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 252:198-205. [PMID: 32622104 DOI: 10.1016/j.ejogrb.2020.06.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To report complications of Acute Fatty Liver of pregnancy (AFLP), a rare liver disease of pregnancy, and identify prognostic factors for mothers and children. STUDY DESIGN We conducted a retrospective descriptive study over 18 years in three French maternities. Demographic, clinical, biological data, and outcomes of patients and their infants were reviewed. RESULTS 142,450 pregnancies from centers were studied. Eighteen patients with AFLP were identified The prevalence of AFLP was estimated as 1/7,914 pregnancies. Prolonged prothrombin time was identified as a risk factor of maternal complications (OR = 0.86, p = 0.0493). Gestational age at delivery was the only risk factor associated with fetal or neonate complications (OR = 0.37, p = 0.0417). One boy died of previously undiagnosed β-oxidation deficiency at eight months. CONCLUSION In AFLP, prothrombin time must be carefully monitored to anticipate major maternal complications. Infants born to mothers with ALFP should be screened as early as possible for mitochondrial fatty acid oxidation deficiency.
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Abstract
Introduction Hyperemesis gravidarum (HG) is said to occur when early pregnancy is complicated by excessive vomiting that leads to electrolyte imbalance, ketosis or loss of more than 5% of the bodyweight. It can be accompanied by deranged liver function tests (LFT), and most patients recover uneventfully with no fetal harm. Methods A retrospective study was conducted by evaluating records of 135 patients who were admitted or underwent day care for HG at our center over a period of 30 months. After excluding patients who were not investigated and those with another pre-existing or newly diagnosed liver disease, 63 patients were enrolled in the study. Their LFT were analyzed with the software Graphpad Prism version 8.4 (GraphPad Software, San Diego, California). The values were expressed as mean ± standard deviation and statistical analysis was done using unpaired t test and simple linear regression. Results The mean age of the study population was 26.59 ± 5.15 years and the mean period of gestation was 13.27 ± 2.48 weeks. 60.3% (38/63) of the patients had some form of abnormality on the LFT. The mean total serum bilirubin (TSB) was 1.56 ± 0.84 mg/dL, mean aspartate transaminase (AST) was 46.63 ± 30.89 U/L and mean alanine transaminase (ALT) was 51.35 ± 42.86 U/L. ALT was higher than AST with statistical significance (p<0.0001). There was no statistically significant difference in the LFT of primigravida and multigravida women. The study population included three diabetic and two hypertensive women, and two women had multiple pregnancy. All the patients were treated with anti-emetics. One patient required corticosteroid administration, and none required termination of pregnancy. Conclusion Mild liver dysfunction in HG can occur in over 50% of the patients. When diagnosis is not in doubt, no further intervention is required with regard to the LFT.
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Affiliation(s)
- Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Saurabh Gaba
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences. Geburtshilfe Frauenheilkd 2020; 80:499-507. [PMID: 32435066 PMCID: PMC7234826 DOI: 10.1055/a-1091-8630] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/15/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 – 18%. Perinatal mortality rates are 7 – 20% and 15 – 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.
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Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Panagiotis Tsikouras
- Democritus University of Thrace, Department of Obstetrics and Gynecology, Alexandroupolis, Greece
| | - Patrick Stelzl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Mhiri R, Mvogo A, Kamga A, Yassinguezo S, Fagla H, Dotou D, Kallel H. Epidemiology and maternal prognosis of hypertension disorders of pregnancy in French Guiana. Pregnancy Hypertens 2020; 20:96-101. [PMID: 32224440 DOI: 10.1016/j.preghy.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/18/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are responsible for high maternal mortality and morbidity worldwide. OBJECTIVE Our primary objective was to report the epidemiological and clinical features of HDP in Cayenne General Hospital. Our secondary objectives were to search for factors associated to preeclampsia (PE) and to severe PE in patients with HDP. METHODS Our study was observational and non-interventional. It was conducted over 4-month period (January to April 2019) in the Obstetrics and Gynaecology Unit of the Cayenne General Hospital. We included all pregnant women after 20 weeks of gestation (WG), who gave birth and who presented HDP and/or PE. RESULTS During the study period 1243 patients gave birth in our unit. Among them, 156 were diagnosed with HDP (12.6%). The median age was 33 years (IQR 28 - 38 years). The most frequent medical histories were diabetes (27.5%) and chronic hypertension (23.5%). The socioeconomic status was low in 31% of patients. Ninety-four patients (61.4%) developed PE with a severe form in 80.9% of cases. HELLP syndrome was diagnosed in 6.5% and nephropathy in 3.3% of cases. Delivery was by cesarean in 49.7% of cases. The median gestational age at delivery was 37 WG (IQR: 35-39). Multivariate analysis showed no independent factors associated with the occurrence of PE or severe PE in patients with HDP. CONCLUSION Our study shows a high prevalence of PE in patients with HDP. Hospitalization and repeated clinical evaluation are needed to screen for women exposed to develop PE or severe PE.
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Affiliation(s)
- Raoudha Mhiri
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana.
| | - Alexandra Mvogo
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Alain Kamga
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Samson Yassinguezo
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Herliche Fagla
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Dominique Dotou
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana
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Azzaroli F, Mazzella G, Marchesini G, Brodosi L, Petroni ML. Fatty liver in pregnancy: a narrative review of two distinct conditions. Expert Rev Gastroenterol Hepatol 2020; 14:127-135. [PMID: 31928239 DOI: 10.1080/17474124.2020.1715210] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Fatty liver is rather common in pregnancy, occurring in two totally different conditions, i.e. nonalcoholic fatty liver disease (NAFLD) in pregnancy and acute fatty liver of pregnancy (AFLP). The former is a common condition, resulting by chance association because of the epidemics of obesity and the older age of many pregnant women in Western countries; the latter is a rare disease whose pathophysiology is still incompletely understood.Areas covered: We reviewed the evidence-based knowledge on fatty liver in/of pregnancy. For NAFLD, a few large retrospective and prospective studies identify immediate and late risks for both the mother and the fetus. For AFLP, only small retrospective studies are available, indicating that prompt delivery and eventual referral to Liver Units for liver support or transplantation are mandatory to avoid maternal and fetal death.Expert opinion: The number of pregnant women with fatty liver is expected to increase in the next years. Pharmacologic treatment of NAFLD might be postponed, even when new drugs are approved by health authorities for the general population. In the case of AFLP, we need to improve our ability to correctly identify and treat the most severe cases not resolving with delivery.
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Affiliation(s)
- Francesco Azzaroli
- Department of Medical and Surgical Sciences, "Alma Mater" University, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Mazzella
- Department of Medical and Surgical Sciences, "Alma Mater" University, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Lucia Brodosi
- Department of Medical and Surgical Sciences, "Alma Mater" University, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences, "Alma Mater" University, Sant'Orsola-Malpighi Hospital, Bologna, Italy
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