Gabaude B, Verna H, Duforestel T, Grimaud D, Delmont J, Gillet J Y
Service Gynécologie-Obstétrique, Hôpital Saint-Roch, Nice.
Rev Fr Gynecol Obstet. 1987 Jul-Sep;82(7-9):483-8.
Severe jaundice during pregnancy is exceptional; it rapidly compromises the maternal and fetal prognosis. The series of seven cases presented in this study (3 acute viral hepatitis, 3 acute steatosis of pregnancy, one uncertain diagnosis), demonstrates the rapid evolution and the major repercussion on the pregnancy (5 premature deliveries, four fetal deaths in 8 children). No maternal death occurred but the complications were practically constant (4 severe haemorrhages, 3 acute renal insufficiencies, one encephalopathy with convulsions). This study permits also to emphasize the difficulty of the diagnosis in the acute phase: laboratory tests are often not very significant and the needle biopsy of the liver is usually contra-indicated; a liver scan (3 cases) may be an interesting alternative. The treatment requires a collaboration between obstetrician and anesthetist. The obstetrical management rests on the condition of the fetus and the etiology since the current tendency is to deal rapidly with the pregnancy, in the presence of an Acute Steatosis.
孕期严重黄疸较为罕见；它会迅速危及母婴预后。本研究呈现的七例病例（3例急性病毒性肝炎、3例妊娠急性脂肪肝、1例诊断不明）显示出病情的快速进展以及对妊娠的重大影响（5例早产，8例胎儿中有4例死亡）。虽未发生孕产妇死亡，但并发症几乎持续存在（4例严重出血、3例急性肾功能不全、1例伴有惊厥的脑病）。本研究还凸显了急性期诊断的困难：实验室检查往往意义不大，肝脏穿刺活检通常属禁忌；肝脏扫描（3例）可能是一种有效的替代方法。治疗需要产科医生和麻醉师的协作。产科管理取决于胎儿状况和病因，因为当前的趋势是在妊娠急性脂肪肝的情况下迅速处理妊娠问题。
