Department of Obstetrics and Gynecology, Beijing Youan Hospital, Capital Medical University, YouAn outer street No.8, Fengtai District, Beijing, 100006, China.
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Qihelou street No.17, Dongcheng District, Beijing, 100006, China.
BMC Pregnancy Childbirth. 2020 May 11;20(1):282. doi: 10.1186/s12884-020-02980-2.
Limited data exists regarding the pregnancy and infant outcomes of Acute Fatty Liver of Pregnancy (AFLP).
Retrospectively collected mothers with AFLP and mothers without AFLP in our center from 1/2008 to 6/2018. The primary assessment was to analyze and compare the frequency of negative maternal and fetal outcomes. The secondary assessment was to investigate the role of intrauterine balloon tamponade in reducing negative maternal outcomes.
Compared to 220 matched mothers, 55 AFLP mothers were younger (P < 0.001), with fewer pregnancies (P = 0.033), complicated with more pregnancy induced hypertension (P < 0.001), twins(P = 0.002), fetal growth restriction (P = 0.044) and male fetus (P < 0.001). 3 (5.5%) of AFLP patients were diagnosed in the postpartum period. Mean gestational week of AFLP diagnosis was 35.25 ± 5.80 weeks. Jaundice (89.1%), nausea or vomiting (58.2%), anorexia (49.1%), fatigue (45.5%) and polydipsia (30.9%) were the main prodromal symptoms. The median duration from diagnosis to delivery was 1.55 ± 4.62 days and 75% (39/52) pregnancy were terminated the pregnancy at the day of diagnosis. 78.8% (41/52) patients received cesarean section, 53.6% (22/41) of which received preventive plasma transfusion before surgery and no one received artificial liver support during the treatment. In comparison, higher frequency of 16 maternal complications, severe negative outcomes (27.3% vs. 0.9%) and newborn asphyxia (24.6% vs.0.9%) were observed in AFLP population. 3 mothers (mortality rates: 5.5%) died of multiple organ system failure and 6 fetus/infants (death rates: 9.8%) died of distress. When compared to those without negative outcomes, patients with negative fetal outcomes were younger (P = 0.042), had more singleton rates (p = 0.041), increased mean value of ALT(P = 0.011) and T-Bilirubin (P = 0.014), decreased prothrombin activity (P = 0.011). Although no statistical significance for the small sample size, there were less refractory postpartum hemorrhage (0% vs.31.3%), hysterectomy (0% vs.12.5%), negative maternal outcomes (16.7% vs.56.3%) in patients underwent intrauterine balloon tamponade when postpartum hemorrhage exceeded 500 ml.
Several symptoms were found to be the main prodromal symptoms of AFLP. Higher frequency of adverse maternal and fetal outcomes was observed in mothers with AFLP than mothers without AFLP. We found five potential risk factors of negative fetal outcomes.
关于妊娠急性脂肪肝（AFLP）的妊娠和婴儿结局，目前数据有限。
从 2008 年 1 月至 2018 年 6 月，我们中心回顾性地收集了 AFLP 母亲和无 AFLP 母亲的数据。主要评估是分析和比较母婴不良结局的发生频率。次要评估是调查宫内球囊填塞术在降低母婴不良结局中的作用。
与 220 名匹配的母亲相比，55 名 AFLP 母亲年龄较小（P<0.001），妊娠次数较少（P=0.033），合并妊娠高血压（PIH）较多（P<0.001）、双胞胎（P=0.002）、胎儿生长受限（P=0.044）和男性胎儿（P<0.001）。3 例（5.5%）AFLP 患者在产后诊断。AFLP 诊断时的平均孕周为 35.25±5.80 周。黄疸（89.1%）、恶心或呕吐（58.2%）、食欲不振（49.1%）、乏力（45.5%）和多饮（30.9%）是主要前驱症状。从诊断到分娩的中位时间为 1.55±4.62 天，75%（39/52）妊娠在诊断当天终止。78.8%（41/52）患者行剖宫产术，其中 53.6%（22/41）术前预防性血浆输注，无患者在治疗期间接受人工肝支持。相比之下，AFLP 患者中更常见 16 种母婴并发症、严重不良结局（27.3% vs.0.9%）和新生儿窒息（24.6% vs.0.9%）。3 名母亲（死亡率：5.5%）死于多器官功能衰竭，6 名胎儿/婴儿（死亡率：9.8%）死于窘迫。与无不良结局的患者相比，有不良胎儿结局的患者年龄较小（P=0.042），单胎率较高（p=0.041），丙氨酸转氨酶（ALT）和总胆红素（T-Bilirubin）均值升高（P=0.011，P=0.014），凝血酶原活动度降低（P=0.011）。尽管由于样本量小，无统计学意义，但在产后出血超过 500ml 时，行宫内球囊填塞术的患者中，产后出血难治性（0% vs.31.3%）、子宫切除术（0% vs.12.5%）和母婴不良结局（16.7% vs.56.3%）的发生率较低。
一些症状被发现是 AFLP 的主要前驱症状。与无 AFLP 母亲相比，AFLP 母亲的母婴不良结局发生率更高。我们发现了五个与不良胎儿结局相关的潜在危险因素。
