Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Japan.
ASAIO J. 2012 Mar-Apr;58(2):174-6. doi: 10.1097/MAT.0b013e3182444ed4.
A 31-year-old pregnant woman was diagnosed as having acute hepatitis of unknown etiology and conservatively treated. An emergency cesarean delivery was performed 5 days later at 33 weeks and 3 days of gestation because of a gradual deterioration in liver function. Two days after the cesarean delivery, she lost consciousness in the evening (Glasgow coma scale [GCS] = 9) because of hepatic encephalopathy and was diagnosed as having fulminant hepatic failure (FHF). Five days after the cesarean delivery, the patient (blood type B) underwent a successful left lobe with caudate lobe (S1+2+3+4) liver transplantation from her father (blood type AB), an ABO-incompatible donor. At 1 year follow-up, she and her baby are in good medical condition. The drastic deterioration in hepatic function, despite intensive plasmapheresis and continuous hemodiafiltration, during the early postpartum period suggested a possible causative association between the termination of pregnancy and progression of FHF from acute hepatitis of unknown etiology.
一位 31 岁孕妇被诊断为不明原因的急性肝炎，并接受了保守治疗。5 天后，即妊娠 33 周零 3 天时，由于肝功能逐渐恶化，进行了紧急剖宫产。剖宫产术后 2 天，患者（B 型血）因肝性脑病于傍晚（格拉斯哥昏迷量表[GCS] = 9）失去意识，被诊断为暴发性肝衰竭（FHF）。剖宫产术后 5 天，来自其父亲（AB 型血，ABO 不相容供体）的血型为 B 的患者成功接受了左外叶加尾状叶（S1+2+3+4）肝移植。1 年后随访时，患者及其婴儿状况良好。尽管在产后早期进行了强烈的血浆置换和持续的血液透析滤过，但肝功能仍急剧恶化，这表明终止妊娠与不明原因的急性肝炎向 FHF 的进展之间可能存在因果关系。
