Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases

被引:134
作者
Castro, MA
Fassett, MJ
Reynolds, TB
Shaw, KJ
Goodwin, TM
机构
[1] Massachusetts Gen Hosp, Div Maternal Fetal Med, Dept Obstet & Gynecol, Boston, MA 02114 USA
[2] Los Angeles Cty Womens & Childrens Hosp, Div Maternal Fetal Med, Dept Obstet & Gynecol, Los Angeles, CA USA
[3] Univ So Calif, Womens & Childrens Hosp, Div Maternal Fetal Med, Dept Obstet & Gynecol, Los Angeles, CA USA
[4] Univ So Calif, Los Angeles Cty Med Ctr, Div Hepatol, Dept Med, Los Angeles, CA 90033 USA
[5] Univ So Calif, Ctr Med, Dept Med, Div Hepatol, Los Angeles, CA 90033 USA
[6] White Mem Med Ctr, Div Maternal Fetal Med, Dept Obstet & Gynecol, Los Angeles, CA USA
关键词
acute fatty liver of pregnancy; liver failure; critical care;
D O I
10.1016/S0002-9378(99)70567-3
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: We sought to describe our experience with the clinical diagnosis, management, and course of patients with acute fatty liver of pregnancy. STUDY DESIGN: Twenty-eight cases of acute fatty liver of pregnancy at the Los Angeles County and University of Southern California Medical Center from 1982 to June 1997 were identified, and presenting symptoms, clinical course, laboratory values, maternal complications, and neonatal outcomes were studied. RESULTS: The incidence of acute fatty liver of pregnancy was 1 in 6659 births. There were no maternal deaths. Initial presentation was at an average of 37 weeks of gestation with a characteristic prodrome of malaise, nausea, vomiting, and abdominal pain. No patient was admitted with the diagnosis of acute fatty liver of pregnancy. The condition was diagnosed most commonly on the second hospital day after laboratory results indicated coagulopathy, renal insufficiency, and liver function abnormalities. One patient underwent liver biopsy at cesarean delivery. Radiologic studies did not aid with the diagnosis. Twenty-one patients were admitted in spontaneous labor, and 16 labors were complicated by abnormal fetal heart rate patterns or meconium. There was 1 stillbirth and 1 neonatal death as a result of perinatal asphyxia. Maternal morbidity consisted of hypoglycemia, infection, renal insufficiency, coagulopathy, encephalopathy, and wound complications. All patients had evidence of disseminated intravascular coagulopathy with profoundly decreased antithrombin levels. All patients recovered normal liver function post partum. CONCLUSIONS: Reversible peripartum liver failure may be diagnosed and managed on the basis of clinical and laboratory criteria. With adequate support, these patients may have full recovery of hepatic function.
引用
收藏
页码:389 / 395
页数:7
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