Liver Disease in The Pregnant Patient

Ca, Riely

doi:10.1111/j.1572-0241.1999.01199.x

Cited by 66 publications

(18 citation statements)

References 49 publications

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“…In our study, none of AFLP cases received liver biopsy because of limited time and risk of hemorrhage. In consistent with previous reports [15][16][17][18][19][20], our study showed ultrasound was not a reliable method for the diagnosis of AFLP.…”

Section: Discussionsupporting

confidence: 84%

Early diagnostic test for acute fatty liver of pregnancy: a retrospective case control study

Zhong

Zhu

Ding

2020

BMC Pregnancy Childbirth

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Background: Early diagnosis is important to lower the mortality rate of acute fatty liver of pregnancy (AFLP). The Swansea criteria is commonly used to diagnose AFLP, but some terms could only be reached when symptoms and signs have progressed, or are not efficient in clinical practice. Therefore, it is necessary to select cost effective tests to simplify and facilitate early suspicion of acute fatty liver of pregnancy. Methods: This is a retrospective study of 28,800 medical records at the Second Xiangya Hospital from 2009 to 2015, including 41 patients with AFLP and 172 other diseases that could show similar symptoms to AFLP. The evaluated variables included past history of liver diseases, blood pressure, gastrointestinal symptoms, blood count, liver function test, coagulation function test and blood sugar test. The sensitivity, specificity, positive predict value and negative predict value were calculated for models in diagnosing AFLP. Results: The significant variables associated with AFLP included gastrointestinal symptoms, blood pressure > 140/ 90 mmHg, aminotransferase> 42 IU/l, total bilirubin> 0.8 mg/dl, total bilirubin acid> 10.0 μmol/L, activated partial prothrombin time(APTT) > 34 s, prothrombin time(PT) > 14 s, white blood cells> 11 *10 6 /l and blood sugar< 72 mg/ dl. Gastrointestinal symptoms +aminotransferase +bilirubin +bile acid +APTT/PT showed 97.6% sensitivity and 97.1% specificity to diagnose AFLP. Adding blood pressure, blood sugar or white blood cells decreased the accuracy of the statistical model. Conclusions: Application of a statistical model including maternal symptoms, biochemical and haematological parameters has high diagnostic accuracy for earlier identification of AFLP. However, this finding needs to be tested in another cohort to determine whether this statistical model has the same performance.

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Section: Discussionsupporting

confidence: 84%

Early diagnostic test for acute fatty liver of pregnancy: a retrospective case control study

Zhong

Zhu

Ding

2020

BMC Pregnancy Childbirth

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“…10 O espectro das complicações hepáticas da EHAG é bastante variado, desde formas oligo ou assintomática até a IHA grave, essa, com elevada mortalidade sendo o transplante hepático considerado o único recurso terapêutico para garantir a sobrevida materna, geralmente indicado após 48 horas do parto quando não ocorre regeneração hepática. [10][11][12][13] Por ser a EHAG de alta morbimortalidade, com necessidade imperiosa do diagnóstico precoce e interrupção da gravidez o que define o prognóstico da gestante e do bebê, o presente estudo tem o objetivo de relatar um caso de EHAG, com suas características clínicas, laboratoriais e condutas terapêuticas adotadas.…”

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Esteatose hepática aguda da gravidez: relato de caso e revisão de literatura

Pinheiro

Brasil

Bruno

et al. 2015

Medicina (Ribeirão Preto)

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A esteatose hepática aguda da gravidez (EHAG) é uma complicação obstétrica rara e grave, que ocorre durante o terceiro trimestre de gestação. O objetivo deste estudo é o relato de caso de EHAG em paciente internada em hospital terciário. Gestante, 36 anos, na 37ª semana de gravidez previamente hígida até quatro dias antes da admissão hospitalar. Iniciou quadro de dor abdominal em epigástrio e hipocôndrio direito, icterícia progressiva, desidratação, febre e calafrios. Evoluiu com piora dos sintomas, hematêmese, hipotensão e hipoglicemia. A função hepática apresentava alterações. O coagulograma revelava tempo de protrombina e de tromboplastina parcial alargados. Os marcadores virais para hepatites A, B e C foram negativos. No pós-operatório imediato da Cesárea, a paciente evoluiu com distúrbio da coagulação, episódios de hipoglicemia, piora da icterícia e encefalopatia hepática, caracterizando o diagnóstico de insuficiência hepática aguda (IHA). Após quatro dias de tratamento da encefalopatia hepática houve melhora do sensório até apresentar-se consciente, orientada, sem flapping, apenas com tratamento conservador e não preencheu os critérios do King’s Collegue de indicação para transplante hepático. No 15o dia de internação tanto a paciente e filho encontravam-se bem. Com o conhecimento e diagnóstico de EHAG, no reconhecimento precoce de casos mais leves, incluindo interrupção precoce da gravidez por cesariana e grandes volume de plasma fresco congelado e albumina, alternadamente, o prognóstico de EHAG pode melhorar.

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“…Maternal-fetal interactions are mostly blamed for the impaired fatty acid beta-oxidation. Indeed, fatty acid oxidation defects have been associated with maternal liver dysfunction (5-8). These defects are autosomal recessive.…”

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confidence: 99%

“…As the first step, liver and coagulation function tests could be performed for any pregnant woman who complains of new-onset gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. If abnormal results are found, further tests should be performed, including renal function tests, blood glucose level, and abdominal ultrasound (5, 11-13). …”

mentioning

confidence: 99%

“…Hence, impaired coagulation function tests should be more prominent as they could have prognostic value (5, 13, 14). In a study by Meng et al involving 43 patients managed in a tertiary care center, the levels of prothrombin time, plasma fibrinogen, and platelet counts were correlated with the recovery time, while the leukocyte count, serum blood glucose, and hepatic aminotransferase levels showed no value in predicting the prognosis (14).…”

mentioning

confidence: 99%

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