Clinical Case Analysis Of Acute Fatty Liver During Pregnancy

Background:Acute fatty liver of pregnancy is a rare obstetric disease occurring in late pregnancy.Epidemiology shows that the incidence of the disease is between 1/7000-1/15000.Although the incidence of the disease is low,it develops rapidly,the maternal and infant mortality rate is high,and the clinical symptoms are lack of specificity,and early diagnosis is difficult.Therefore,early diagnosis and timely treatment are still difficult and key points in clinical work.Abjective:To study the characteristics of clinical cases of acute fatty liver in pregnancy,summarize the most common clinical symptoms and abnormal laboratory examination results of acute fatty liver in pregnancy,improve the ability of early diagnosis and timely treatment,so as to improve the pregnancy outcomes of pregnant women and fetuses.Methods:1.Statistics Subei people’s Hospital of Jiangsu Province from January 2012 to January 2019 diagnosed as acute fatty liver in pregnancy clinical data of 24 cases,collected its general clinical data,mainly including patient age,gestational age,parity,number of births,fetal sex,etc.,statistics of 24 cases of symptoms,laboratory indicators,imaging examination,treatment methods,adverse pregnancy outcomes and neonatal outcomes of patients.2.Total bilirubin level is one of the indicators reflecting liver function.When total bilirubin value is greater than 171 umol/L,it can reach the diagnostic criteria of severe hepatitis.24 patients were divided into two groups.Group A:TBiL value>171 umol/L at admission,a total of 10 cases.Group B:TBiL value<171 umol/L at admission,a total of 14 cases.The adverse pregnancy outcomes of each group were statistically compared.Rsults:1.The age of onset was 21-37 years old.The gestational age of onset was 30-38w+5.There were 18 primipara(75.0%)and 6 transpartum women(25.0%).There were 22 singleton pregnancies(91.7%)and 2 twin pregnancies(8.3%).2.There were 16 cases of abdominal pain(66.7%),8 cases of vomiting(33.3%),4 cases of jaundice(16.7%),2 cases of anorexia and fatigue(8.3%),1 case of polyuria and thirst(4.2%),2 cases of lower limb edema(8.3%),and 4 cases of no obvious pre-symptoms(16.7%).Abdominal pain and vomiting were the most common.3.Leukocyte count increased in 24 patients at admission,PT and APTT prolonged in varying degrees,FIB decreased in 21 patients and platelet changes were not specific;24 patients had obvious abnormalities of transaminase and total bilirubin,4 patients had abnormal blood ammonia,12 patients had blood sugar value less than 4 mmol/L(50.0%),20 patients had abnormal uric acid(83.3%),14 patients had abnormal blood creatinine(58.3%)and urine.Four cases(16.7%)had abnormal nitrogen.Among the laboratory indicators,total bilirubin,aminotransferase,leukocytosis and prolongation of PT and APTT were the most common.Twenty-four patients were examined by B-mode ultrasonography.The results of B-mode ultrasonography in 15 patients showed that the liver was bright,and the positive rate was about 75%.4.Twenty-four patients were terminated by emergency cesarean section within 24 hours from diagnosis of AFLP to termination of pregnancy.13 patients were seriously ill after operation and transferred to ICU for further treatment.None of the 24 patients died.5.On the first day after termination of pregnancy,the FIB value of 24 patients was higher than that before termination(P<0.05);the levels of ALT,AST,TBiL,Cr and UA were lower than that before termination(P<0.05);the levels of WBC,PLT,PT,APTT,BA,Glu and BUN had no significant change after termination of pregnancy(P>0.05).6.24 patients,the main complications include acute renal failure(ARF),hepatic encephalopathy,postpartum hemorrhage,DIC.The incidence of ARF,postpartum hemorrhage,hepatic encephalopathy and DIC in group A was higher than that in group B.There was statistical difference in the above adverse prognosis between the two groups(P<0.05).7.Twenty-six fetuses were delivered,including 22 singletons and 2 twins,16 boys(61.5%)and 10 girls(38.5%)and the weight of newborns(2188.0±600.7)g and Apgar 5-minute score(7.5±2.6).Nineteen neonates were transferred to NICU after birth.The incidence of neonatal hypoglycemia,hypocalcemia,liver dysfunction and kidney dysfunction in group A was higher than that in group B.The incidence of neonatal hypoglycemia and liver dysfunction was significantly different between the two groups(P<0.05),while the incidence of neonatal hypocalcemia and kidney dysfunction was not significantly different between the two groups(P>0.05).The incidence of neonatal asphyxia,death,ischemic-hypoxic encephalopathy and pathological jaundice in group A was higher than that in group B.There were statistical differences in the incidence of neonatal death and pathological jaundice between the two groups(P<0.05);there was no statistical difference in the incidence of neonatal asphyxia and ischemic-hypoxic encephalopathy between the two groups(P>0.05).Conclusion:1.The clinical symptoms of AFLP are atypical,including vomiting,abdominal pain,jaundice,anorexia and fatigue,and abdominal pain and vomiting are the most common symptoms.Abnormal liver function,blood routine,coagulation routine and/or renal function often occur in patients with AFLP.Among these indicators,total bilirubin,aminotransferase,leucocyte elevation and prolongation of PT and APTT are the most common.The positive rate of liver B-mode ultrasonography is about 75%.Taking these common abnormalities into account,it is helpful for early diagnosis.2.ARF,hepatic encephalopathy,postpartum hemorrhage and DIC were more likely in patients with TBiL>171 umol/L.When TBiL value is greater than 171 umol/L,neonates are more likely to suffer from hypoglycemia,abnormal liver function,neonatal death and pathological jaundice.3.For confirmed AFLP patients,especially those whose TBiL value is greater than 171 umol/L,timely termination of pregnancy and multidisciplinary treatment should be strengthened to improve the treatment level of acute fatty liver in pregnancy and the prognosis of mother and infant.