Acute Fatty Liver Of Pregnancy: A Case Report And Review

Purpose: Acute fatty liver in pregnancy is a rare and high mortality obstetric disease.The pathogenesis of acute fatty liver is not clear.In recent years,with the improvement of understanding of the disease,maternal mortality and perinatal mortality have decreased significantly.A retrospective analysis was made on the diagnosis and treatment of acute fatty liver in pregnancy in our hospital.The experience of treatment was summarized to provide the basis for further improving the survival rate of mother and infant.Methods: Review of the clinical data statistics of the First Hospital of Jilin University treatment of 21 cases with acute fatty liver of pregnancy during the period of 2010 March to 2016 November,were analyzed for their medical records.According to the outcome of pregnancy,the patients were divided into 14 cases in survival group and in death group 7 cases.From the clinical manifestations,the duration of termination of pregnancy,method of termination of pregnancy,artificial liver treatment,complications and other comparative analysis,so as to get a positive treatment.Results: 1.Gestational age: All of the 21 cases patients in the third trimester,of which there were 2 multiparas and 19 primiparas.The perinatal survival rate was about 54%.2.Clinical symptoms:From clinical manifestation in the survival group,clinical jaundice occurs in 6 women,gastrointestinal symptoms were observed in 8 people.And in the death group,1 people showed jaundice,gastrointestinal symptoms was observed in 5 people.There was no significant difference between survival group and death group.3.Laboratory index:There are different degrees of abnormality in two groups of patients with blood,liver and kidney functions and other laboratory indexes.No difference between the two groups was dominant.4.Termination of pregnancy time:The survival rate of patients with termination of pregnancy within 7 days from onset was 81%,and the survival rate was 20% in 7 days,and the difference between the two groups was different.5.The termination of pregnancy:5 cases of vaginal delivery,9 cases of cesarean section.In the death group,2 cases of vaginal delivery,5 cases of cesarean section.In the survival group,3 cases were treated with subarachnoid block,and the other group received general anesthesia.The women in the death group were treated with subarachnoid block in 1 case,and 4cases received general anesthesia.The two groups had no significant difference.6.The time and manner of artificial liver:survival group 5 cases of hemofiltration,respectively in the 1-3 days after birth while,in the death group,6 cases of blood filtration,respectively in the 1-5 days after delivery.Among the survival group 2 cases of plasma exchange,both in hepatic encephalopathy after 1 days,and in the death group 1 cases of blood plasma replacement on hepatic encephalopathy after 4 days.7.Complications: there were 1-5 complications in the survival group,and the number of complications in the death group was 4-8.Conclusion: To improve the survival rate of mother and son,we need to improve hospital doctors cognition of the disease,prenatal care project,especially for the occurrence of gastrointestinal symptoms,early detection and diagnosis,timely termination of pregnancy,select the appropriate delivery and anesthesia,postoperative intensive care,timely application of artificial liver treatment,blood products,blood coagulation factor,albumin and for various complications,positive symptomatic treatment.