Obstetrics, Gynecology and Maternal-Fetal Medicine, The Winfred L. Wiser Hospital for Women and Infants, The University of Mississippi Medical Center, Jackson, MS, USA.
Obstetrics and Gynecology, The Winfred L. Wiser Hospital for Women and Infants, The University of Mississippi Medical Center, Jackson, MS, USA.
J Matern Fetal Neonatal Med. 2022 Sep;35(18):3595-3601. doi: 10.1080/14767058.2020.1832075. Epub 2020 Oct 9.
To review the presenting signs, symptoms, laboratory findings, clinical courses, complications, and maternal outcomes in women determined on medicolegal review to have had acute fatty liver of pregnancy (AFLP).
We retrospectively studied case files from women with medical and/or hypertensive complications of pregnancy which had been reviewed by the first author, deidentified and divested of legal documents so that only medical-related information was retained for later research and teaching purposes. Main outcomes are 12 lessons learned from this review to be offered for the future benefit of clinicians encountering patients with AFLP.
Eleven women with AFLP were identified within the 161 file database. Signs and symptoms present in 91-100% of women with AFLP were altered sensorium, a fast resting maternal pulse >100/min, gastrointestinal complaints, muscle pain and evidence of fetal compromise/stillbirth. Laboratory findings in 91-100% revealed abnormal liver, renal and coagulation tests, hyperuricemia, and very low serum glucose and albumin. A correct initial diagnosis of AFLP was made for only three women; the most common incorrect presumptive diagnosis was HELLP syndrome. Four women survived. Twelve major findings are discussed.
Rapid, timely and thorough evaluation of third trimester women presenting with (Altered mental status changes/extreme sleepiness), (Fast resting pulse >100 in the absence of fever or heart causation), (Liver-related gastrointestinal complaints) and (Pain as myalgias and body aches), often in association with evidence of fetal compromise or stillbirth, should initiate efforts to investigate a possible diagnosis of AFLP. Adoption of the concepts summarized including core initial laboratory testing, immediate patient transfer to tertiary care, and aggressive correction of consumptive coagulopathy could form the basis of a patient safety bundle to guide future management for patients with AFLP.
回顾法医学审查确定为妊娠急性脂肪肝（AFLP）的女性的临床表现、症状、实验室检查结果、临床病程、并发症和母婴结局。
我们回顾性研究了作者对患有医学和/或妊娠高血压并发症的女性的病例档案，这些档案经过去识别和去除法律文件，以便仅保留与医疗相关的信息，用于以后的研究和教学目的。主要结果是从这次审查中总结出 12 个经验教训，以供未来遇到 AFLP 患者的临床医生参考。
在 161 份档案数据库中确定了 11 名 AFLP 女性。91-100%的 AFLP 女性存在以下症状和体征：意识改变、休息时母亲脉搏超过 100/分钟、胃肠道症状、肌肉疼痛和胎儿窘迫/死胎的证据。91-100%的实验室检查结果显示肝、肾和凝血功能异常、高尿酸血症以及极低的血清葡萄糖和白蛋白。只有 3 名女性得到了正确的初始 AFLP 诊断，最常见的错误推测诊断是 HELLP 综合征。4 名女性存活。讨论了 12 个主要发现。
对于在妊娠晚期出现（精神状态改变/极度嗜睡）、（休息时脉搏超过 100 次/分钟，无发热或心脏原因）、（与肝脏相关的胃肠道症状）和（疼痛如肌痛和全身疼痛）的女性，应迅速、及时和全面地评估，通常与胎儿窘迫或死胎有关，应努力调查可能的 AFLP 诊断。采用包括核心初始实验室检查、立即将患者转至三级护理、积极纠正消耗性凝血功能障碍在内的概念，可以作为指导未来 AFLP 患者管理的患者安全套餐的基础。
