Analysis Of Diagnosis And Treatment Of 7 Cases Of Severe Pregnancy With Acute Fatty Liver

Objective:Acute fatty liver in pregnancy is an idiopathic and fatal disease that occurs in late pregnancy and postpartum.The incidence is low,and the onset is acute,rapid development,and the condition is dangerous.The retrospective analysis of the diagnosis and treatment process of hospitalized patients with acute fatty liver during pregnancy in our hospital is conducted to summarize the treatment experience and provide basis for further improving the survival rate of mother and child.Methods:We retrospectively analyzed the clinical data of 7 severe AFLP patients admitted to the First Affiliated Hospital of Nanchang University from February 2016 to February 2018.Analyze the patient’s clinical features,the comprehensive treatment plan during the perinatal period,the prognosis,and the complications after delivery.Results:(1)Clinical characteristics of 7 patients:(1)Onset of gestational age: 7 cases were all onset in the third trimester,and gestational weeks ranged from 33 to 40 weeks with an average of 36.22±2.07 weeks.(2)Clinical Symptoms: 5 patients had different degree of anorexia,nausea,vomiting,abdominal pain,diarrhea and other upper gastrointestinal symptoms before admission.Systemic jaundice occurred in 7 patients.(3)Laboratory indexes: coagulation,liver,and 7 patients.Renal function and other laboratory indicators have varying degrees of abnormalities.(4)Onset time: 3 patients with a course of less than 7 days and 4 patients with more than 7 days.(2)Termination of Pregnancy: One case of fetal death before admission was spontaneously delivered vaginally,and the remaining 6 cases were all undergoing caesarean section.(3)Peri-implantation pre-treatment: 6 cases of surgical patients were preoperatively infused with plasma and cryoprecipitate to correct coagulation dysfunction,and 1 case was infused with plasma and cryoprecipitate to correct coagulation dysfunction during vaginal delivery.(4)Blood loss during delivery was800-1950 ml,average bleeding was 1325 ml,6 cases of cesarean section performed uterine artery ascending branch ligation,and 3 cases underwent uterine gauze packing.(5)Postoperative artificial liver treatment and its curative effect: There were 1plasmapheresis 2 times,4 plasmapheresis 3 times,and 1 plasmapheresis 4 times and 9times.TBIL,DBIL,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and creatinine(Cr)decreased after treatment with plasmapheresis Obviously,albumin(AIB)was higher than before treatment,and coagulation function was examined for prothrombin time(PT),activated partial thromboplastin time(APTT),and fibrinogen(FIB)significantly improved;fatigue,loss of appetite,etc.Significant improvement in clinical symptoms(6)Complications and Outcomes: 7 patients experienced varying degrees of infection and hypoproteinemia during treatment,1patient developed hypoglycemia,1 patient had gastrointestinal motor dysfunction,and 1 patient developed hypertension.With acute left heart failure,1 case of low pathogenic enterococcus infection,4 cases of hepatic encephalopathy,gastrointestinal bleeding in 2 cases,were cured after symptomatic treatment were discharged.Conclusions:(1)The clinical manifestations of acute fatty liver during pregnancy are not specific,early detection,early diagnosis,and timely termination of pregnancy are critical for AFLP;(2)Plasma exchange therapy is safe and effective in the acute fatty liver of pregnancy and can significantly improve AFLP.Patients with liver and kidney function and coagulation parameters,improve patient prognosis;(3)AFLP complications,deep understanding and active prevention and treatment of the disease can significantly reduce the mortality rate.