Pregnancy outcomes in women with acute fatty liver of pregnancy referred to Mashhad University Hospitals in 2013-2018

Document Type : Original Article

Authors

1 General Physician, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate professor, Department of Obstetrics and Gynecology, Fellowship of Pelvic Floor Disorders, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant professor, Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Acute fatty liver of pregnancy (AFLP) has been noticed due to high mortality rate for mother and fetus. However, the cause and pathogenesis of AFLP are unclear, and the absence of specific symptoms precludes early diagnosis and effective treatment. Therefore, this study was performed with aim to investigate the pregnancy outcomes in patients with acute fatty liver of pregnancy.
Methods: This cross-sectional descriptive study was performed in 2013-2018. A total of 1475 records of women suspected to acute fatty liver of pregnancy, HELLP syndrome, severe pre-eclampsia and Thrombotic Thrombocytopenic Purpura (TTP) who were hospitalized in the university hospitals of Mashhad were selected and evaluated. Chief complaints at admission, laboratory data and pregnancy outcomes were evaluated. Data were analyzed by SPSS software (version 23).
Results: A total of 34 records with diagnosis of AFLP were included in this study. Nausea and vomiting (94.11%), abdominal pain (94.11%) and hypertension (52.94%) were three main complaints in these patients, respectively. Laboratory test showed an increase in bilirubin, liver enzymes, coagulation tests, creatinine and a decrease in albumin and platelet count. Mean gestational age at the time of pregnancy termination was 34.2±2.04 weeks. We found 5 cases of maternal and 4 cases of neonatal mortality. Mean recovery time was 6.03±2.53 days.
Conclusion: AFLP is associated with maternal mortality and the complications like multi organ failure, Diseminated intravascular coagulation, preterm labor, postpartum hemorrhage, and neonatal mortality. Since in this study, the most common complications of patients with AFPL were nausea, vomiting and abdominal pain, it is recommended to evaluate all pregnant women in third trimester who refer with these symptoms for diagnosis of AFLP.

Keywords

References

  1.  

    1. Cunningham FG, Leveno KJ, Bloom SL, Spong C, Dashe JS, Hoffman BL, et al. Williams obstetrics. 25nd ed. New York: McGraw-Hill; 2018.
    2. Zhang YP, Kong WQ, Zhou SP, Gong YH, Zhou R. Acute fatty liver of pregnancy: a retrospective analysis of 56 cases. Chinese medical journal 2016; 129(10):1208-14.
    3. Vigil-de Gracia P, Montufar-Rueda C. Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases. The Journal of Maternal-Fetal & Neonatal Medicine 2011; 24(9):1143-6.
    4. Palmer J, Borhart J. What Is Acute Fatty Liver of Pregnancy?. InGastrointestinal Emergencies 2019:375-6.
    5. Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P. A prospective national study of acute fatty liver of pregnancy in the UK. Gut 2008; 57(7):951-6.
    6. Goel A, Ch LC, Ch E, Balasubramanian K, Elias E. Acute Fatty Liver of Pregnancy Better Understanding of Pathogenesis and Earlier Clinical Recognition Results in Improved Maternal Outcomes. EMJ Hepatol 2018; 6(1).
    7. Aldika Akbar MI, Mayang Sari I, Aditiawarman, Dachlan EG, Dekker G. Clinical characteristics of acute fatty liver of pregnancy in a tertiary Indonesian hospital. The Journal of Maternal-Fetal & Neonatal Medicine 2019; 32(5):826-32.
    8. Seyyed Majidi MR, Vafaeimanesh J. Plasmapheresis in acute Fatty liver of pregnancy: an effective treatment. Case reports in obstetrics and gynecology 2013; 2013.
    9. Mikolasevic I, Filipec-Kanizaj T, Jakopcic I, Majurec I, Brncic-Fischer A, Sobocan N, et al. Liver disease during pregnancy: a challenging clinical issue. Medical science monitor: international medical journal of experimental and clinical research 2018; 24:4080-90.
    10. Italian Association for the Study of the Liver (AISF. AISF position paper on liver disease and pregnancy. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2016; 48(2):120-37.
    11. Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. American journal of obstetrics and gynecology 2013; 209(5):456-e1.
    12. Liu G, Shang X, Yuan B, Han C, Wang Y. Acute Fatty Liver of Pregnancy: Analysis on the Diagnosis and Treatment of 15 Cases. The Journal of reproductive medicine 2016; 61(5-6):282-6.
    13. Meng J, Wang S, Gu Y, Lv H, Jiang J, Wang X. Prenatal predictors in postpartum recovery for acute fatty liver of pregnancy: experiences at a tertiary referral center. Archives of gynecology and obstetrics 2016; 293(6):1185-91.
    14. Wu Z, Huang P, Gong Y, Wan J, Zou W. Treating acute fatty liver of pregnancy with artificial liver support therapy: Systematic review. Medicine 2018; 97(38):e12473.
    15. Liu J, Ghaziani TT, Wolf JL. Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. American Journal of Gastroenterology 2017; 112(6):838-46.
    16. Allen AM, Kim WR, Larson JJ, Rosedahl JK, Yawn BP, McKeon K, et al. The epidemiology of liver diseases unique to pregnancy in a US community: a population-based study. Clinical Gastroenterology and Hepatology 2016; 14(2):287-94.
    17. Xiong HF, Liu JY, Guo LM, Li XW. Acute fatty liver of pregnancy: over six months follow-up study of twenty-five patients. World Journal of Gastroenterology: WJG 2015; 21(6):1927-31.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 24, Issue 6
September 2021
Pages 17-24

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