scholarly journals Pregnancy Outcomes of Patients with Acute Fatty Liver of Pregnancy：A Case Control Study

2020 ◽  
Author(s):  
Lingzhi Chang ◽  
Ming Wang ◽  
Haixia Liu ◽  
Qinghua Meng ◽  
Hongwei Yu ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Postpartum Hemorrhage ◽  
Small Sample ◽  
Maternal Outcomes ◽  
Negative Outcomes ◽  
Fetal Outcomes ◽  
Prodromal Symptoms ◽  
Balloon Tamponade ◽  
Organ System Failure ◽  
Acute Fatty Liver

Abstract Background : Limited data exists regarding the pregnancy and infant outcomes of Acute Fatty Liver of Pregnancy (AFLP). Methods: Retrospectively collected mothers with AFLP and mothers without AFLP in our center from 1/2008 to 6/2018. The primary assessment was to analyze and compare the frequency of negative maternal and fetal outcomes. The secondary assessment was to investigate the role of intrauterine balloon tamponade in reducing negative maternal outcomes. Results: Compared to 220 matched mothers, 55 AFLP mothers were younger (P<0.001), with fewer pregnancies (P=0.033), complicated with more pregnancy induced hypertension (P<0.001), twins(P=0.002), fetal growth restriction (P=0.044) and male fetus (P<0.001). 3 (5.5%) of AFLP patients were diagnosed in the postpartum period. Mean gestational week of AFLP diagnosis was 35.25±5.80 weeks. Jaundice (89.1%), nausea or vomiting (58.2%), anorexia (49.1%), fatigue (45.5%) and polydipsia (30.9%) were the main prodromal symptoms. The median duration from diagnosis to delivery was 1.55±4.62 days and 75% (39/52) pregnancy were terminated the pregnancy at the day of diagnosis. 78.8% (41/52) patients received cesarean section, 53.6% (22/41) of which received preventive plasma transfusion before surgery and no one received artificial liver support during the treatment. In comparison, higher frequency of 16 maternal complications, severe negative outcomes (27.3% vs. 0.9%) and newborn asphyxia (24.6% vs.0.9%) were observed in AFLP population. 3 mothers (mortality rates: 5.5%) died of multiple organ system failure and 6 fetus/infants (death rates: 9.8%) died of distress. When compared to those without negative outcomes, patients with negative fetal outcomes were younger (P=0.042), had more singleton rates (p=0.041), increased mean value of ALT(P=0.011) and T-Bilirubin (P=0.014), decreased prothrombin activity (P=0.011). Although no statistical significance for the small sample size, there were less refractory postpartum hemorrhage (0% vs.31.3%), hysterectomy (0% vs.12.5%), negative maternal outcomes (16.7% vs.56.3%) in patients underwent intrauterine balloon tamponade when postpartum hemorrhage exceeded 500ml. Conclusions: Several symptoms were found to be the main prodromal symptoms of AFLP. Higher frequency of adverse maternal and fetal outcomes was observed in mothers with AFLP than mothers without AFLP.We found five potential risk factors of negative fetal outcomes.

scholarly journals Pregnancy Outcomes of Patients with Acute Fatty Liver of Pregnancy

2019 ◽  
Author(s):  
Lingzhi Chang ◽  
Ming Wang ◽  
Haixia Liu ◽  
Qinghua Meng ◽  
Hongwei Yu ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Postpartum Hemorrhage ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Small Sample ◽  
Negative Outcomes ◽  
Fetal Outcomes ◽  
Prodromal Symptoms ◽  
Organ System Failure ◽  
Acute Fatty Liver

Abstract Background: Limited data exists regarding the pregnancy and infant outcomes of Acute Fatty Liver of Pregnancy (AFLP).Methods: Retrospectively collect the mothers with AFLP and without AFLP in our center from 1/2008 to 6/2018.The primary assessment was to analyze and compare the frequency of negative maternal and fetal outcomes. The secondary assessment was to identify the predictors of negative maternal and fetal outcomes. Results: Compared to 220 matched mothers, 55 AFLP mothers were younger (P<0.001 ), fewer pregnancies(P=0.033),with more pregnancy induced hypertension(P<0.001), twins(P=0.002), fetal growth restriction(P=0.044) and fetus male (P<0.001). 3 (5.5%) of AFLP patients were diagnosed in the postpartum period. The mean gestational ages were 35.25±5.80 weeks at diagnosis of AFLP before delivery and Jaundice(89.1%), nausea or vomitting(58.2%), anorexia(49.1%), fatigue(45.5%) and like cold drinks(30.9%) were the main prodromal symptoms. The median duration from diagnosis to delivery was 1.55±4.62 days and 75%(39/52) patients terminate the pregnancy at the day of diagnosis. 78.8%(41/52) patients received cesearean section for terminating the pregnancy. 53.6%(22/41) patients received preventive plasma transfusion before the surgery and no one received artificial liver support during the treatment. In comparison, higher frequency of 16 maternal complications, severe negative outcomes (27.3% vs. 0.9%) and newborn asphyxia (24.6% vs.0.9%) were observed in AFLP population. 3 mothers (mortality rates: 5.5% ) died of multiple organ system failure and 6 fetal/infant (death rates: 9.8%) died of distress. When compared to those without negative outcomes, younger mothers(P=0.042),more singleton rates (p=0.041),increased mean value of ALT(P=0.011) and T-Bilirubin(P=0.014), decreased prothrombin activity(P=0.011) were predictors of the negative fetal outcomes. Although no statistical significance for the small sample size, the occurence of refractory postpartum hemorrhage (0% vs.31.3% ), hysterectomy(0% vs.12.5% ), negative marternal outcomes (16.7% vs.56.3% ) were significantly decreased in patients with postpartum hemorrhage exceeded 500ml. Conclusions: Several symptoms were found to be the main prodromal symptoms of AFLP. Higher frequency of adverse maternal and fetal outcomes was observed in mothers with AFLP than common people.We found five potential risk factors of negative fetal outcome. Intrauterine balloon pressure might prevent further postpartum bleeding , but need further verification.

scholarly journals Acute Fatty Liver of Pregnancy: A Life Threatening Condition

2020 ◽  
Vol 15 (1) ◽  
pp. 79-80
Author(s):  
Sarita Sitaula ◽  
Ajay Agrawal ◽  
Achala Thakur ◽  
Tara Manandhar ◽  
Babauram Dixit Thapa ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Postpartum Hemorrhage ◽  
Post Partum ◽  
High Morbidity ◽  
Third Trimester ◽  
Delay In Diagnosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Acute Fatty Liver ◽  
Catastrophic Disease

Acute Fatty Liver of Pregnancy (AFLP) is a rare but catastrophic disease affecting women in pregnancy. It usually occurs in the third trimester or post-partum period. Delay in diagnosis is associated with morbid complications with high morbidity and mortality. We report a case of 24 years old female at 38 weeks period of gestation who presented with jaundice, vomiting for 3 days and deranged liver function test. She was diagnosed as acute fatty liver of pregnancy and was delivered by instrumental delivery but required cesarean hysterectomy due to postpartum hemorrhage. She started improving with supportive care and discharged after 4 weeks of hospital stay. Key words: AFLP, Hysterectomy, Postpartum hemorrhage

Coagulopathy from Severe Postpartum Hemorrhage.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4145-4145
Author(s):  
Andra H. James ◽  
Michael Paglia ◽  
Chad Grotegut ◽  
Betty Thames ◽  
Terry Gernsheimer
Keyword(s):  
Fatty Liver ◽  
Organ Dysfunction ◽  
Postpartum Hemorrhage ◽  
Hellp Syndrome ◽  
Medical Center ◽  
Fresh Frozen Plasma ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Packed Red Blood Cells ◽  
Acute Fatty Liver

Abstract OBJECTIVE: The purpose of this study was to estimate the incidence and risk factors associated with coagulopathy from severe postpartum hemorrhage. STUDY DESIGN: After approval by the Institutional Review Board at Duke University Medical Center, records with the ICD-9 code 666.12 for immediate postpartum hemorrhage were reviewed for the 5-year period from January 1, 2000, to December 31, 2004. Severe postpartum hemorrhage was defined as postpartum hemorrhage requiring transfusion. Coagulopathy from postpartum hemorrhage was defined as severe postpartum hemorrhage requiring factor replacement. RESULTS: During this period there were 12,476 deliveries. 108 had severe postpartum hemorrhage. 30/108 became coagulopathic. They received a total of 108 units of fresh frozen plasma (FFP) and 12 units of cryoprecipitate (cryo). 28/30 also received 1 to 20 units of packed red blood cells and 5/30 received 1 to 3 units of platelets. All of the women who received cryo had also received FFP. The trigger for administration of factor replacement was clinical (oozing, continued bleeding) in 13/30 cases and a prolonged partial thromboplastin time (PTT) in 17/30 cases. Peak PTTs ranged from 27 to &gt; 150 seconds. Lowest fibrinogen levels ranged from 27 to 580. In 2 cases, however, no fibrinogen levels were obtained. Hemorrhage was attributed to uterine atony in 11/30 cases, placenta accreta in 6/30, lacerations or incisions in 6/30, HELLP syndrome in 2/30, acute fatty liver of pregnancy in 1/30, amniotic fluid embolism in 1/30, fibroids, in 1/30, hemorrhage into an ovarian fibroma in 1/30, and chronic hepatitis B in 1/30. 22/30 cases were associated with cesarean delivery. In 12/30 cases hysterectomy was performed. Hospital length of stay ranged from 2 to 11 days with a mean of 5.4. 9/30 women spent from 1 to 3 days in the ICU. There were no deaths. 2 women had evidence of organ dysfunction from HELLP syndrome or acute fatty liver of pregnancy, but none developed organ dysfunction as a consequence of severe postpartum hemorrhage. CONCLUSION: 2.4 per 1000 women developed coagulopathy as a result of severe postpartum hemorrhage. They received an average of 4 units of either FFP or cryo. 90% of the units were FFP and 10% were cryo. While 30% of the women required intensive care, all survived with no sequelae.

Maternal Outcomes After Uterine Balloon Tamponade for Postpartum Hemorrhage

2016 ◽  
Vol 36 (1) ◽  
pp. 32-33
Author(s):  
E. Martin ◽  
M.-T. Cheve ◽  
G. Legendre ◽  
O. Multon ◽  
L. Sentilhes ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Maternal Outcomes ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

Maternal outcomes after uterine balloon tamponade for postpartum hemorrhage

2015 ◽  
Vol 94 (4) ◽  
pp. 399-404 ◽  
Author(s):  
Emmanuelle Martin ◽  
Guillaume Legendre ◽  
Pierre-Emmanuel Bouet ◽  
Marie-Therese Cheve ◽  
Olivier Multon ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Maternal Outcomes ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

TO EVALUATE THE EFFECTIVENESS OF CONDOM BALLOON CATHETER IN TREATING INTRACTABLE POSTPARTUM HEMORRHAGE AT KONTUM PROVINCIAL HOSPITAL

2018 ◽  
Vol 8 (6) ◽  
pp. 178-183
Author(s):  
Dinh Nguyen Gia ◽  
Thanh Cao Ngoc
Keyword(s):  
Maternal Death ◽  
Postpartum Hemorrhage ◽  
Medical Management ◽  
Balloon Catheter ◽  
Uterine Atony ◽  
Cross Sectional ◽  
Common Cause ◽  
Provincial Hospital ◽  
Balloon Tamponade ◽  
Condom Catheter

Background: Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbility and mortality and accounts for 31% of maternal death in Vietnam. The most common cause of PPH is uterine atony. Recently, uterine tamponade using intrauterine condom appears to be an effective tool in the management of intractable PPH. Objectives: To evaluate the success of condom as a tamponade to arrest intractable PPH due to uterine atony in patients not responding to medical management. Materials and Methods: The study was designed as a cross-sectional and descriptive, included 32 patients who underwent condom balloon tamponade at Kontum Provincial Hospital from 1/2012 to 8/2016. Results: 32 women (mean age 25.71 ± 6.45 years range, 16 - 39) underwent condom balloon tamponade for PPH controls. 29 patients (90.62%) successfully responded the tamponade therapy by the use of condom catheter. Three patients (9.37%) required hysterectomy. Conclusions: Condom catheter balloon effectively controls the intractable PPH due to uterine atony. Key words: PPH (Pospartum hemorrhage), Tamponade, Condom catheter balloon, Uterine atony

Acute Fatty Liver of Pregnancy From 18 Weeks’ Gestation

Hepatology ◽  
2020 ◽  
Vol 71 (6) ◽  
pp. 2167-2169 ◽  
Author(s):  
Mimi Wong ◽  
Frances Hills ◽  
Katrina Vogler ◽  
Ibrahim Zardawi ◽  
Nirjhar Nandi
Keyword(s):  
Fatty Liver ◽  
Acute Fatty Liver
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