Frequency and Severity of Liver Involvement in Hypertensive Disorders of Pregnancy

Abstract

Background: Pre-eclampsia (PE) and eclampsia (E) are among the leading causes of maternal and fetal morbidity and mortality. Both are associated with an evolving spectrum of liver disorders. Objective: The aim of this study was to evaluate the frequency and severity of liver involvement in pregnant women admitted to an intensive care unit with PE/E and to assess its influence on adverse maternal and fetal outcomes. Methods: All subjects, hospitalized between January 2012 and March 2019, were retrospectively evaluated for clinical and biochemical liver-related abnormalities and their frequencies were subsequently correlated with maternal-fetal outcomes. Results: A total of 210 women (mean age 31±6.4 years, mean gestational age 33.8±4.1 weeks) with PE/E were included in the study. Most of them had severe hypertension (n=184) and symptoms of abdominal pain (48%) and headache (40%). Liver enzymes abnormalities were seen in 49% of the subjects, usually less than five times the upper limit of normal. Subcapsular hemorrhage and spontaneous hepatic rupture were identified in one woman who died. No patient had definitive diagnosis for acute fatty liver of pregnancy, neither acute liver failure. A total of 62% of deliveries occurred before 37 weeks. Fetal mortality was observed in 6 (3%) cases. There was no correlation between mean levels of liver enzymes and maternal and fetal outcomes. Conclusion: Biochemical abnormalities of liver enzymes are frequently seen in women with PE/E, but outside the spectrum of HELLP syndrome, they are not associated with adverse maternal and fetal outcomes. Liver-related complications are rare but can be life-threatening.

Prevalência E Evolução Clínica De Hematoma Hepático Na Síndrome Hellp Em Maternidade De Teresina

“…A pré-eclâmpsia (PE) e a eclâmpsia (E) estão entre as principais causas de morbidade e mortalidade materna e fetal e, ambas, estão associadas a um espectro evolutivo de distúrbios como alterações da coagulação, hemólise, enzimas hepáticas elevadas, e síndrome de baixa contagem de plaquetas (HELLP). A insuficiência hepática aguda, hematomas subcapsulares hepático e esplênico e infarto hepático podem estar associados (Oliveira et al, 2022).…”

The Evolving Field of Hepatology in Brazil

“…Those results reinforce the importance of physical activity in the management of patients with cirrhosis to prevent malnutrition and frailty. Oliveira et al (19) have reported that quite half of those patients with pre-eclampsia and eclampsia have abnormal liver enzymes when admitted to the ICU, usually outside the spectrum of HELLP syndrome. Maternal and fetal mortality was negligible and few have developed life-threatening liver related complications.…”

Investigar la prevalencia de hipotiroidismo subclínico en pacientes preeclámpticas y normotensas

“…(33) También observaron en este estudio retrospectivo anomalías de AST y/o ALT en la mitad de los pacientes, la mayoría de ellos tenían ligeras elevaciones de las enzimas hepáticas hasta cinco veces el límite superior normal, pero el 12 % mostró fluctuaciones moderadas a severas de AST y/o ALT. (34) Recuento plaquetario y LDH en las pacientes normotensas y preeclámpticas se obtuvo una p. que es estadísticamente significativa como se esperaba encontrar más disminuidas las plaquetas y las LDH incrementadas que es parte de las complicaciones maternas en la preeclampsia (11) los valores de creatinina en pacientes normotensas y preeclámpticas al igual que en las mujeres preeclámpticas con y sin signos de severidad no hubo una p estadísticamente significativa lo que nos indica que no hubo complicaciones renales.…”