Acute fatty liver of pregnancy: Retrospective analysis

Year 2003, Volume: 34 Issue: 1, 1 - 6, 01.02.2003

Selçuk Arslan Önder Koç Ümmügülsüm Koç Görkem Tuncay

Abstract

Objective: Our purpose was to investigate the diagnostic problems and to assess maternal and perinatal outcome in cases of fatty liver of pregnancy. Material and method : Eight cases with acute fatty liver of pregnancy managed during the past two years were studied with emphasis on presenting symptoms, admitting diagnosis, laboratory findings,clinical course, maternal complications and neonatal outcome. Results: The mean gestational age at onset was 34 weeks (range 31-40) Only two patients had acute fatty liver of pregnancy as a definite or suspected diagnosis on admission. Computed tomography and ultrasonography of the liver was performed on five patients .We performed liver biopsy other three patients. There was one maternal death, however,maternal morbidity was frequent. Two patients had hepatic ancep halopathy, three ascites ,and one renal failure. The corrected perinatal mortality was 142 in 1000. Conclusion: Acute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclarnpsia in the presence of hypoglycemia, low fibrinogen and prolonged prothrombine time particularly in the absence of severe abruptio placenta In spite of the literature's dismal prognosis ,our findings indicate that maternal and perinatal outcomes appear favorable in well managed patients.

Keywords

Retrospective Studies, Fatty Liver, Pregnancy, Pre-Eclampsia

Gebeliğin akut yağlı karaciğeri: Retrospektif analiz

Abstract

Amaç : Gebeliğin akut yağlı karaciğeri olgularında, tanısal problemleri, gebeliklerin nasıl sonuçlandığını ve maternal mortaliteyi araştırmaktır. Materyal ve metod : Ocak 2000 - Mayıs 2002 tarihleri arasında, gebeliğin akut yağlı karaciğeri tanısı konulan 8 hasta, semptomları, yatış tanıları, laboratuar bulguları, klinik seyir, maternal komplikasyonlar ve yeni doğanın durumu gibi parametreler dikkate alınarak değerlendirildi. Sonuçlar : Semptomlar ortalama 34. Gebelik haftasında ( ranj 31-40 ) ortaya çıkmaktaydı. Hastalardan ikisinde ön tanı olarak gebeliğin akut yağlı karaciğeri düşünülmüştü. Üç hastada tanı karaciğer biopsisiyle kesinleştirilirken, 5 hastada tanı kompüterize tomografi veya ultrasonografi ile konuldu . Bir hasta ex olurken, iki hastada hepatik ansefalopati, üç hastada karında yaygın asit ve bir hastada renal yetmezlik saptandı. Düzeltilmiş perinatal mortalite binde 142 olarak hesaplandı. Tartışma: Şiddetli, plasenta dekolmanı olmayan, hipoglisemi, hipofibrinojenemi, uzamış protrombin zamanı saptanan preekamptik olgularda gebeliğin akut yağlı karaciğerinden şüphelenilmelidir. Literatürdeki çok sayıda kötü sonuçlanan gebeliğe rağmen, erken ve doğru yaklaşımla daha iyi sonuçlar elde edildi.

Keywords

Geriyedönük çalışma, Yağlı karaciğer, Gebelik, Preeklampsi

References

• 1. Kaplan MM. Acute fatty liver of pregnancy. N Engl. J. Med. 1985; 313: 367-70
• 2. Barton JR, Sibai BM, Mabie WC, Shanklin DR. Recurrent acute fatty liver pregnancy. Am J Obstet Gynecol 1990; 163: 534-8
• 3. Brenner WF. Edelman DA, Hendricks CH. A standart of fetal growth for the United States of America. Am J Obstet Gynecol. 1976; 126: 55-64
• 4. Varner M, Rinderknecht NK. Acute fatty metamorphosis of pregnancy:A maternal mortality and literatüre review. J Reprod Med 1980; 24:177-80
• 5. Moise KJ. Jr, Shah DM. Acute fatty liver of pregnancy etiology of fetal distress and fetal vastage. Obst. Gynecol 1987; 69: 482-5
• 6. Riely CA, Latham PS, Romero R, Duff TR Acute fatty liver of pregnancy. A reassessment based on observations in nine patients. Ann Latern Med. 1987; 106: 703- 7. Burrough AK, Seong NG, Dojcinov DM, Scheur PJ, Sheriock SV. Idiopathic acute fatty liver of pregnancy in 12 patients. Ql Med 1982; 204:481-97
• 8. Pahros PJ, Petes RT, Reynolds TB. Idiopathic fatty liver of pregnancy: findings in ten cases. Medicine 1983; 63:449-52
• 9. Watson MJ, Seed JW. Acute fatty liver of pregnancy. Obstet Gynecol Surv. 1990; 45:585-91
• 10. Gastrointestinal disorders. In Cun ning-ham GH , MacDonald PC , Gant NF , Leveno KJ , Gilstrap LC , eds. Williams obstetrics The Me Graw- Hill Companies , 2001 :1285-1287
• 11. Treem WR ,Rinaldo P , Hale DE , Stanley CA , Mellington D , Hyams JS et. al.Acute fatty liver of pregnancy and long -chain 3-hydroxyacyl - coenzyme A dehydrogenase deficiency Hepatology 1994 ;19 :339-45
• 12. Mac Kenna J, Puphin M, Crenshaw C, Mcleod M. Parker RT. Acute fatty- metamorphosis of the liver. A report of two patients who survived. Am J Obstet Gynecol 1987; 127: 400-4
• 13. Riley C A. Acute fatty liver of pregnancy. Semin Liver Dis 1987; 7: 47-54
• 14. Arias F, Mancilla-Jimenez R. Hepatic 15. Campülo B, Bernvav J Wite MO, et al Ultrasonography in acute fatty liver of pregnancy. Ann Intern Med . 1986; 105: 383-4
• 16. Van Le L, Podrashy A. Computed tomography and ultrasonographic findings in women acute fatty liver of pregnancy. J Reprod Med 1990; 35: 815-7 17. Me Kee CW, Weir PW, Foster JH, et al. Acute fatty liver of pregnancy and dignosis by computed tomography. BMJ 1986; 292:-291-2
• 18. Jwayyed SM, Elanda M, Kubina M. Acute fatty liver of pregnancy. J Emerg Med 1999; 17(4): 673-7
• 19. Usta IM, Barton JR, Amon EA, Gonzalez A, Sibai BM. Acute fatty liver of pregnancy: An experience in the diagnosis and management of fourteen cases. Am J Obstet Gynecol 1994; 171: 1342-1347
• 20. Yang W, Shen Z, Peng G, Chen Y, et al. Acute fatty liver of pregnancy: diagnosis and management of 8 cases. Chin Med J (Engl)2000; 113(6): 540-3 21. Castro MA, Fassett MJ, Reynolds TB, Shaw KJ, et al. Reversible peripartum failure: A new perspective on the diagnosis, treatment and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol 1999; 181: 389-95
• 22. Mabie WC, Dacus JV, Sibai BM, Morretti ML, et al. Computed tomgraphy in acute fatty liver of pregnancy. Am J Obstet Gynecol 1988; 158: 142-145
• 23. Kissin CM, Adm EJ, Joseph AEA. Acute fatty liver of pregnancy and diagnosis by computed tomography. Br Med J 1986; 296: 622
• 24. Foster KJ, Dewbury KC, Griffith AH, et al. The accuracy of ultrasound in the dedec-tion of fatty infiltration of the liver. Br J Radiol 1982; 53: 440-4
• 25. Needleman L, Kurtz AB, Riflrin MD, et al . Sonography of diffuse benign liver disease: Accuracy of pattern recognition and grading. Am J Roentgenol 1986; 146: 1011-5
• 26. Bova JG, Schenker S. . Acute fatty liver of pregnancy. N EnglJ Med 1985; 313: 1608-11.