Analysis Of Clinical Outcome Of 91 Cases Of Acute Fatty Liver Of Pregnancy

Background:Acute Fatty Liver of Pregnancy(AFLP)is a rare disease during pregnancy,usually occurs in the third trimester,more common in the first maternal,twin pregnancy,has a fatal effect on the mother and fetus.The current incidence of acute fatty liver during pregnancy is considered to be between 1/7000-1/16000,the maternal mortality rate is 15%,and the perinatal mortality rate is 12.5%.Early stage of acute fatty liver in pregnancy may only be nausea,vomiting,fatigue,epigastric pain or headache.A few days later,pregnant women developed jaundice,and they progressively deepened without itching.In addition,some pregnant women do not have abdominal pain,mainly manifested as vomiting,accompanied by skin stasis,ecchymosis,gastrointestinal bleeding,bleeding gums and other symptoms,severe hypoglycemia,consciousness disorders and other mental symptoms and hepatic encephalopathy,oliguria,Without urine and renal failure and other symptoms of multiple organ failure.Although the incidence of the disease is very low,the maternal and child mortality rates are high.Early diagnosis and timely treatment can improve the outcome of mother and child.Objective:This study retrospectively analyzed the clinical data of 91 patients with acute fatty liver during pregnancy in our hospital,analyzed the characteristics of this type of patients,discussed the patient's pregnancy outcomes,explored the progress of treatment of acute fatty liver during pregnancy,and provided relevant experience in clinical practice.In order to reduce maternal and perinatal mortality.Methods:In this study,a retrospective analysis was used to collect 91 patients with acute fatty liver disease in the First Affiliated Hospital of Zhengzhou University from January 1,2012 to December 31,2017.The clinical data of all patients were reviewed,and the data of neonatal outcomes and patients' outcome were collected.According to the maternal outcome,the patients were divided into two groups: a total of 62 patients were discharged from the hospital and group A,and 29 patients were discharged automatically and died in group B.The clinical data of the two groups were compared,and the characteristics of patients with acute fatty liver during pregnancy were analyzed.Results:1.The study included 91 patients with acute fatty liver of pregnancy aged 18~43 years,with an average age of 27.16±5.05 years.There was no significant difference in age and gestational age between the two groups.There was a statistically significant difference between the AFLP and the patient's outcome before admission,c2=9.976,P=0.002.2.All patients showed different degrees of liver function and renal function and coagulation dysfunction.Compared with the two groups,PT(s),APTT(s),TT(s)and D-two dimers had statistical difference(P<0.05),and FIB(g/L)had no statistical difference(P>0.05).3.There was no significant difference in liver function GLU(mol/L),ALT(U/L)and AST(U/L)between the two groups(P>0.05),TBIL(mol/L)had statistical difference(P<0.05).Creatinine(mol/L)was statistically different(P<0.05),uric acid had no statistical difference(P>0.05).4.In this study,54 patients in group A were terminated by cesarean section,and 8 patients had vaginal delivery.In group B,2 patients were critically ill when hospitalized,without termination of pregnancy.The patients and their families required discharge from discharge,23 cases of cesarean termination and 4 cases of vaginal delivery.The two groups of patients with acute fatty liver during pregnancy had a cesarean section rate of c2=0.059 and P=0.808.There was no significant difference in delivery mode between the two groups.5.91 cases of acute fatty liver of pregnancy,19 cases died of fetal death at admission.In 53 newborns born in our hospital,44 cases had different levels of amniotic fluid pollution.There were 10 cases of amniotic fluid pollution,4 cases of amniotic fluid pollution,and 30 cases of amniotic fluid pollution.The neonatal Apgar score of 1 minutes was 6.59 ± 2.91 points,and the 5 minute Apgar score was 8.13 ±2.54 points.conclusion1.Early diagnosis and timely treatment in patients with acute fatty liver during pregnancy can improve the outcome of patients and neonates.2.The degree of coagulation dysfunction in patients with acute fatty liver during pregnancy is related to the outcome of patients.3.Serum total bilirubin and creatinine levels in patients with acute fatty liver during pregnancy are related to the outcome of patients.