Analysis Of Death Cases Of Hepatic Failure During Pregnancy In The Last 12 Years Of Zhejiang Province

Background During the last 12 years, the maternal mortality has been decreased significantly in Zhejiang Province, mainly by diminishing the death cases of obstetric hemorrhage and hypertensive disorders complicating pregnancy,while the death cases of hepatic disease during pregnancy has not been changed too much by comparison. Among these death cases of hepatic disease during pregnancy, the cases of hepatic failure during pregnancy are the majority. So we aim to describe the characteristics, share the experience, derease the mobidity,and inrease the chance of success in treatment of hepatic failure during pregnancy by reviewing the death cases of hepatic failure during pregnancy in the last 12 years of Zhejiang Province. Methods Analyze the death cases of hepatic failure during pregnancy in the last 12 years of Zhejiang Province according to the information that has been reported by local hospitals, which contains the the basic informantion, antenatal examination history, treatment course and death related information of these patients. Results The centre of perinatal disease control of Zhejiang Province has received a tatal of 51 death cases of hepatic failure during pregnancy in the last 12 years. Their ages goes from 18 to 39(average 28). Except 3 patients with their compensations unknown, only 3 of them had good economic supports, while 30 had their incomes at average level by local standards, and another 15 with poor payments from their jobs. 41 patients were allowed to have their new babies, while 10 patients were not allowed by Family Planning Policy. Among the 10 cases, 2 cases are belong to the previous 6 years, but not fluid population, the other 8 cases, which belong to the latter 6 years, includes 4 cases of fluid population(50%). There are 6 cases with unknown prenatal check-up time, 6 cases without any prenatal check-up, which also contains 5 cases that are not allowed to be pregnant by Family Planning Policy, and the average prenatal check-up time of the rest is 5 times. 34 patients referred their first complaints to gastrointestinal uncomfortableness, while 8 jaundice, 2 edema, another 4 patients, each referred their first complaints to tired feeling, coma, fever, and unusual amount bleeding. The other 3 patients recognized their problems only after blood test. The average onset time is 32 gestational week, it takes 1 week averagely when the patients first ask their doctors for help since the onset of the disease, and takes another 4.4 days till the correct diagnosis had been made. There are 7 cases without any transfer treatment, 27 cases had one transfer treatment history, while 10 cases twice, 4 cases three times, and 3 cases more than four times. Of all the 51 patients, 24 got hepatic encephalopathy,while 16 postpartum hemorrhage, 21 DIC, 12 hepatorenal syndrome, and 6 infection. With 7 cases of unknown neonatal prognosis, there are 14 stillbirth, 4 neonates died after delivery, while 22 alive, and 4 cases had abortion. The average survival time after correct diagnosis is 6 days and 4 hours, while after delivery 6 days. Among the 42 cases that has maternal death audit reports,25 deaths are unaviodable, and 17 deaths could have been avoided. Conclusion Hepatic failure during pregnancy can be death-threatening, strengthing the perinatal health care system for the high risk pregnant women, hostipals with good treatments affordable, early diagnosis, overall treatment, termination of pregnancy at a proper time, and effective transfer treatment when necessary should be considered.