Caring for the woman with acute fatty liver of pregnancy

Timely identification and successful treatment of acute fatty liver of pregnancy without obvious clinical symptoms: Case reports

RATIONALE

Acute fatty liver of pregnancy (AFLP) is a rare and potentially fatal complication that occurs in the third trimester or early postpartum period. The diagnosis of AFLP is based on typical clinical and laboratory features and imaging examinations.

PATIENT CONCERNS

Case 1: a 25-year-old pregnant woman was hospitalized for threatened preterm birth at gestation of 35weeks and 2 days gestation. Laboratory tests revealed liver dysfunction, coagulopathy, hypoglycemia, hypoproteinemia, leukocytosis, and elevated creatinine and uric acid levels. Case 2: a 28-year-old (nulliparous) became pregnant after in vitro fertilization-embryo transfer at 29 weeks and 1 days' gestation and came to the obstetric ward for vaginal bleeding. At 34 weeks and 1 day, laboratory investigations showed high serum creatinine, uric acid, liver dysfunction, coagulopathy, and hypoglycemia.

DIAGNOSES

Two patients did not show obvious clinical symptoms, while the ultrasound findings confirmed a diagnosis of AFLP.

INTERVENTIONS

Immediate delivery and comprehensive supportive treatment are the most important methods for the treatment of AFLP.

OUTCOMES

The 2 patients and their babies were discharged from the hospital in a good condition.

LESSONS

Special attention should be paid to mothers with AFLP after in vitro fertilization-embryo transfer. The clinical presentation of AFLP is variable, hence laboratory features and ultrasound examination may be important methods for screening for AFLP.

Pregnancy outcomes in women with liver disease: Is pregnancy safe? A cross-sectional study

Background

There is evidence suggesting that the pregnancy outcome may be affected by some medical conditions, such as liver diseases.

Objective

The present study aimed to investigate the prevalence of liver disease and its outcomes in pregnant women referred to antenatal clinic in the hospital.

Materials and Methods

In this cross-sectional study, all pregnant women with abnormal liver function test attending antenatal clinic affiliated to Shahid Beheshti University of Medical Sciences were recruited from August 2017 to July 2018. All participants were followed-up until delivery with respect to the maternal and neonatal outcome.

Results

Of a total of 7,121 pregnant women recruited in the study, 110 (1.58%) women were detected with a liver disease; of these, 105 women were diagnosed with pregnancy-specific liver diseases, including HELLP syndrome (10.9%), preeclampsia (50.98%), partial HELLP (0.9%), eclampsia (0.9%), acute fatty liver (9.1%), intra-hepatic cholestasis 25 (22.7%), and 5 women the non-pregnancy-specific liver disease, including Liver transplantation (2.7%), and Autoimmune hepatitis (1.8%). Prevalence of the premature birth was 64.5% in pregnancy-specific liver disease, but no premature birth was detected in cases with liver transplantation. We found that neonatal mortality was significantly associated with neonatal prematurity (p = 0.013), IUGR (p < 0.001), placental pathology (p = 0.04), we had no maternal mortality.

Conclusion

Liver disease is not uncommon in pregnancy. This study demonstrated that pregnancy is safe in women with liver disease.

Acute fatty liver of pregnancy in a Chinese Tertiary Care Center: a retrospective study

PURPOSE

To describe some prenatal clinical features and laboratory findings of AFLP and provide the clinicians with potential predictors in postpartum recovery time.

METHODS

Forty-four cases of AFLP previously treated in the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed.

RESULTS

The maternal and fetal mortalities after treatment were both 18.2%. The main symptoms of AFLP were nausea and vomiting (63.6%), jaundice (61.4%). Moreover, the most common maternal complication was acute renal dysfunction (79.5%), followed by DIC (47.7%) and MODS (38.6%). The level of platelets, total protein and total bilirubin were found to be correlated with postpartum recovery time (Pearson correlation coefficient 0.434, P = 0.008; 0.466, P = 0.005; 0.484, P = 0.003).

CONCLUSIONS

AFLP is a rare, but lethal complication in the third trimester. Termination of pregnancy should be applied once AFLP was highly suspected. Prenatal platelets, total protein and total bilirubin may be potential predictors of postpartum recovery.

Maternal Death and Its Investigation

Maternal deaths are a leading cause of death in young females worldwide, particularly in developing countries. Maternal mortality ratio, the number of maternal deaths per 100 000 live births, averages 240 in developing regions, but only 16 in developed regions. Causes of maternal and pregnancy-related deaths can be subdivided into three broad categories. Direct maternal deaths result from obstetric complications of the pregnant state (i.e., pregnancy, labor, and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect maternal deaths result from previously existing diseases or diseases that developed during pregnancy, and which are not due to a direct obstetric cause, but are aggravated by the physiologic effects of pregnancy. Incidental maternal deaths are those from causes unrelated to pregnancy or the puerperium, including accidental deaths and homicide. Maternal deaths carry significant short- and long-term impacts for family members and the role of the pathologist is an important part of the wider knowledge-gathering process that can contribute to changes in maternal mortality rates. This paper reviews the clinical and pathological features of common pregnancy-related disorders and gives guidelines for performing an autopsy related to maternal death.

Readiness, Recognition, Response, and Reporting in a Case of Acute Fatty Liver of Pregnancy

Acute fatty liver of pregnancy (AFLP) occurs less frequently than similarly challenging complications in pregnancy. Early recognition is key to reduce morbidity and mortality. Women present with symptoms common to many illnesses, and AFLP typically occurs in the third trimester. Laboratory test values typical of preeclampsia and HELLP syndrome are seen with AFLP. There are distinguishing laboratory tests that help differentiate AFLP from other conditions. AFLP can cause coagulopathy, which can pose a challenge in childbirth. The case example presented here shows the readiness, recognition, and response of a team caring for a woman with AFLP. System processes developed before this event served the team well during the event. Strong team dynamics of communication, leadership, roles, and a culture of huddles and debriefs are shown.

Effect of nursing intervention under medical guidance on pregnancy outcome in patients with liver dysfunction in late pregnancy

AIM

To compare the pregnancy outcome between pregnant women with liver dysfunction in late pregnancy who received different nursing interventions and explore the effect of nursing intervention on the outcome of pregnancy, in order to reduce the risk of pregnant women and ensure maternal and child safety.

METHODS

From October 2014 to October 2015, 160 pregnant women with liver dysfunction in late pregnancy treated at our hospital were divided into an experimental group (84 cases) and a control group (76 cases). The control group was given routine nursing, and the intervention group was given routine nursing under medical guidance. Preterm birth, cesarean delivery, polyhydramnios, hypertension, urinary tract infection, postpartum hemorrhage, fetal distress and the incidence of neonatal asphyxia and neonatal hyperbilirubinemia were compared between the two groups.

RESULTS

After nursing intervention, premature birth, cesarean delivery, polyhydramnios, hypertension, urinary tract infection, postpartum hemorrhage, fetal distress and other symptoms of pregnancy were significantly reduced in the experimental group than in the control group (P < 0.05). The incidence of neonatal asphyxia and neonatal hyperbilirubinemia rate were significantly lower in the experimental group than in the control group (P < 0.05).

CONCLUSION

For patients with liver dysfunction in late pregnancy, nursing intervention under medical guidance can improve the pregnancy outcome.