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Guria J, Gupta RK. Dual Tragedy of Fetal and Maternal Loss: A Case of Acute Liver Failure in the Third Trimester. Cureus 2024; 16:e59421. [PMID: 38826597 PMCID: PMC11140229 DOI: 10.7759/cureus.59421] [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] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
The traditional criteria for diagnosing preeclampsia include a new onset of hypertension and new-onset proteinuria at 20 weeks gestation. However recent studies suggest preeclampsia and even eclampsia may develop in the absence of either proteinuria or hypertension. This paper reports a dual tragedy of maternal and fetal loss after 36 weeks in the third trimester. Autopsy findings revealed an enlarged liver with multiple patchy hemorrhages, and histopathology confirmed submassive hepatic necrosis. Early diagnosis with timely referrals to higher centers is always helpful for the patients in such cases.
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Affiliation(s)
- Jyotish Guria
- Forensic Medicine and Toxicology, Manipal Tata Medical College, Jamshedpur, IND
| | - Rakesh K Gupta
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Raipur, IND
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Peng Q, Zhu T, Huang J, Liu Y, Huang J, Zhang W. Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers. BMC Pregnancy Childbirth 2024; 24:27. [PMID: 38178044 PMCID: PMC10765840 DOI: 10.1186/s12884-023-06233-w] [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: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Acute fatty liver of pregnancy (AFLP) is an uncommon but potentially life-threatening complication. Lacking of prognostic factors and models renders prediction of outcomes difficult. This study aims to explore factors and develop a prognostic model to predict three-month mortality of AFLP. METHODS This retrospective study included 78 consecutive patients fulfilling both clinical and laboratory criteria and Swansea criteria for diagnosis of AFLP. Univariate and multivariate cox regression analyses were used to identify predictive factors of mortality. Predictive efficacy of prognostic index for AFLP (PI-AFLP) was compared with the other four liver disease models using receiver operating characteristic (ROC) curve. RESULTS AFLP-related three-month mortality of two medical centers was 14.10% (11/78). International normalised ratio (INR, hazard ratio [HR] = 3.446; 95% confidence interval [CI], 1.324-8.970), total bilirubin (TBIL, HR = 1.005; 95% CI, 1.000-1.010), creatine (Scr, HR = 1.007; 95% CI, 1.001-1.013), low platelet (PLT, HR = 0.964; 95% CI, 0.931-0.997) at 72 h postpartum were confirmed as significant predictors of mortality. Artificial liver support (ALS, HR = 0.123; 95% CI, 0.012-1.254) was confirmed as an effective measure to improve severe patients' prognosis. Predictive accuracy of PI-AFLP was 0.874. Area under the receiver operating characteristic curves (AUCs) of liver disease models for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) and pregnancy-specific liver disease (PSLD) were 0.781, 0.774, 0.744 and 0.643, respectively. CONCLUSION TBIL, INR, Scr and PLT at 72 h postpartum are significant predictors of three-month mortality in AFLP patients. ALS is an effective measure to improve severe patients' prognosis. PI-AFLP calculated by TBIL, INR, Scr, PLT and ALS was a sensitive and specific model to predict mortality of AFLP.
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Affiliation(s)
- QiaoZhen Peng
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - TeXuan Zhu
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, 450052, China
| | - JingRui Huang
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - YueLan Liu
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China
| | - Jian Huang
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital, Central South University, Hunan, Changsha, 410011, China
| | - WeiShe Zhang
- Department of Obstetrics, Xiangya Hospital, Central South University, Hunan, Changsha, 410008, China.
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Shan D, Dai S, Chen Q, Xie Y, Hu Y. Hepatoprotective agents in the management of intrahepatic cholestasis of pregnancy: current knowledge and prospects. Front Pharmacol 2023; 14:1218432. [PMID: 37719856 PMCID: PMC10500604 DOI: 10.3389/fphar.2023.1218432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is characterized by unexplained distressing pruritus in the mother and poses significant risk to the fetus of perinatal mortality. Occurring in the second and third trimester, the serum bile acid and aminotransferase are usually elevated in ICP patients. Ursodeoxycholic acid (UDCA) is the first line drug for ICP but the effectiveness for hepatoprotection is to a certain extent. In ICP patients with severe liver damage, combination use of hepatoprotective agents with UDCA is not uncommon. Herein, we reviewed the current clinical evidence on application of hepatoprotective agents in ICP patients. The underlying physiological mechanisms and their therapeutic effect in clinical practice are summarized. The basic pharmacologic functions of these hepatoprotective medications include detoxification, anti-inflammation, antioxidation and hepatocyte membrane protection. These hepatoprotective agents have versatile therapeutic effects including anti-inflammation, antioxidative stress, elimination of free radicals, anti-steatohepatitis, anti-fibrosis and anti-cirrhosis. They are widely used in hepatitis, non-alcoholic fatty liver disease, drug induced liver injury and cholestasis. Evidence from limited clinical data in ICP patients demonstrate reliable effectiveness and safety of these medications. Currently there is still no consensus on the application of hepatoprotective agents in ICP pregnancies. Dynamic monitoring of liver biochemical parameters and fetal condition is still the key recommendation in the management of ICP pregnancies.
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Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Siyu Dai
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Qian Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yupei Xie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yayi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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Ertaş S, Ünver G, Gonca Okumuş Z, Yılmaz S, Dağ İ, Turhan U. Maternal serum Sortilin-1 level as a potential biomarker for intrahepatic cholestasis of pregnancy. Gynecol Endocrinol 2022; 38:935-938. [PMID: 36068972 DOI: 10.1080/09513590.2022.2119957] [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] [Indexed: 01/18/2023] Open
Abstract
Objective: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease related to pregnancy in women. Sortilin-1 is a sorting receptor belonging to the vacuolar protein sorting 10 (Vps10p) domain family, and recent studies have shown that Sortilin-1 has a distinct role in the pathogenesis of biliary fibrosis and cirrhosis. We aimed to evaluate maternal serum Sortilin-1 level as a potential biomarker in pregnant women with intrahepatic cholestasis.Materials and methods: A prospective observational cohort study was conducted. We enrolled 80 pregnant women, 49 with the diagnosis of intrahepatic cholestasis of pregnancy and 31 healthy controls. Then, we measured maternal serum Sortilin-1 levels using an enzyme-linked immunosorbent assay method and compared them between groups.Results: The mean Sortilin-1 level in the ICP group was higher than control group (3.3 ± 1.7 ng/mL vs. 2.0 ± 0.6 ng/mL, respectively, p < .001). The receiver operating characteristic curve (ROC) analysis based on maternal serum Sortilin-1 levels to predict the presence of ICP was 85.3% controls [area under the curve (AUC), 0.853; 95% CI, 0.738-0.938, p < .001]. The optimal cutoff value of Sortilin-1 was 2.24 ng/mL (71.4% sensitivity and 74.2% specificity) to detect intrahepatic cholestasis of pregnancy.Conclusion: Elevated maternal serum Sortilin-1 levels are associated with ICP and can be used as a disease biomarker. Sortilin-1 levels can be combined with total bile acids, transaminases, and blood coagulation profile in the follow-up of ICP.
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Affiliation(s)
- Sinem Ertaş
- VKV American Hospital, Women's Health Center, İstanbul, Turkey
| | - Gökhan Ünver
- Samsun Training and Research Hospital, Samsun, Turkey
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Proença ICT, Miri MR, Marinho JP, Bock PM, de Abreu TM, Pinto MS, Blembeel AS, Ferreira AS, Andrades M, da Rosa Araújo AS, Funchal C, Pochmann D, Dani C. Gestational purple grape juice consumption does not change fetal ductus arteriosus constriction in Wistar rats. Birth Defects Res 2022; 114:525-535. [PMID: 35484956 DOI: 10.1002/bdr2.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Abstract
Grape juice consumption may influence the early occurrence of ductal constriction during pregnancy, since the consumption of foods rich in polyphenols can be linked to the premature constriction of the ductus arteriosus. This study aimed to evaluate the effect of purple grape juice consumption during gestation on fetal ductus arteriosus closure, prostaglandin levels, and oxidative stress markers in Wistar rats. We divided 18 pregnant rats into four groups: a control group (C), a single-dose grape juice group (SDGJ), a two-dose grape juice group (TDGJ) of 7 μl/g body weight per day, and an indomethacin group (I). Blood was collected on gestational day (GD) 0, 14, and 20. Prostaglandin levels were measured, and the livers and hearts were removed from the mothers and fetuses for oxidative stress analysis; histology of the fetal ductus arteriosus was performed. Prostaglandin levels (pg/ml) at GD 20 were (C:1462.10 ± 314.61); (SDGJ:987.66 ± 86.25); (TDGJ:1290.00 ± 221.57), and (I:584.75 ± 46.77). Fetal ductus arteriosus closure occurred only in the indomethacin group. Lipid peroxidation evaluated through thiobarbituric acid reactive substances (nmol/mg protein) in maternal livers was lower in the grape juice groups (C: 4.11 ± 0.76 nmol/mg protein), (SDGJ: 2.34 ± 0.36), (TDGJ: 1.52 ± 0.18), and (I: 4.20 ± 0.76). Sulfhydryls (nmol/mg protein) were lower in the TDGJ group (C:763.59 ± 61.38 nmol/mg protein), (SDGJ:978.88 ± 158.81), (TDGJ:385.32 ± 86.78), and (I:727.72 ± 49.12). Also, superoxide dismutase activity (USOD/mg protein) was higher in fetal hearts in this group: (C:5.29 ± 0.33), (SDGJ:4.48 ± 0.47), (TDGJ:7.35 ± 0.43), and (I:6.00 ± 0.18). We conclude that grape juice consumption in pregnancy does not induce ductus arteriosus closure in the fetus and presented potential antioxidant effects.
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Affiliation(s)
| | - Malena Rostirola Miri
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Jéssica Pereira Marinho
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | | | - Tamires Marques de Abreu
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Milene Santana Pinto
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Amanda Stolzenberg Blembeel
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Aimée Souto Ferreira
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Michael Andrades
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Cláudia Funchal
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Daniela Pochmann
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Caroline Dani
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
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