Paulina Banach, Kuczkowska Justyna, Areshchanka Yulia, Banach Weronika, Rzepka Jakub, Kudliński Bartosz, Rzepka Rafał
Department of Gynecology and Obstetrics, Collegium Medicum, University of Zielona Góra, 65417 Zielona Góra, Poland.
Poznan University of Medical Sciences, 61701 Poznań, Poland.
J Clin Med. 2025 Mar 17;14(6):2028. doi: 10.3390/jcm14062028.
This article presents the case of a 31-year-old primigravida who experienced acute liver failure in the 23rd week of pregnancy, along with a review of the literature on this rare condition during pregnancy. The purpose of this publication is to highlight the diagnostic and therapeutic challenges associated with acute liver failure in pregnant women. The patient presented with jaundice, pruritus, and dark-colored urine. Laboratory tests revealed a significant increase in aminotransferase, bilirubin, and bile acid levels, suggesting liver problems; however, due to the patient's rapidly deteriorating condition and test results, autoimmune hepatitis was considered. Viral infections and other causes of liver damage were excluded. No clear diagnosis was established. The patient was administered ursodeoxycholic acid and due to her worsening condition, a cesarean section was performed at 23 weeks of gestation. After delivery, the patient's condition improved, although she did experience cardiac arrest during hospitalization. The patient was discharged with a diagnosis of acute liver failure in the course of an overlap syndrome of autoimmune hepatitis and primary cholangitis or intrahepatic cholestasis of pregnancy. No abnormalities were noted during a follow-up visit 6 weeks after delivery. Despite a detailed case analysis, a final diagnosis was not established, which complicates planning for future pregnancies. Several liver conditions can occur during pregnancy, including intrahepatic cholestasis of pregnancy, primary biliary cholangitis, and autoimmune hepatitis. Diagnosing these conditions can be challenging due to overlapping symptoms and metabolic and immunological adaptations during pregnancy that can affect the course of liver diseases. Rapid intervention is crucial to protect the health of both the mother and the fetus. In summary, this article aims to increase awareness of the complexities surrounding acute liver failure during pregnancy, highlighting the diagnostic challenges and importance of prompt medical intervention for the well-being of both the mother and the child. This paper aims to provide a comprehensive overview of the complexities surrounding acute liver failure during pregnancy, aiming to improve the understanding, diagnosis, and management of this condition.
本文介绍了一名31岁初产妇的病例，该产妇在妊娠第23周时出现急性肝衰竭，并对孕期这种罕见病症的相关文献进行了综述。本出版物的目的是强调与孕妇急性肝衰竭相关的诊断和治疗挑战。患者出现黄疸、瘙痒和深色尿液。实验室检查显示转氨酶、胆红素和胆汁酸水平显著升高，提示肝脏问题；然而，由于患者病情迅速恶化及检查结果，考虑为自身免疫性肝炎。排除了病毒感染和其他肝脏损伤原因。未明确诊断。给予患者熊去氧胆酸治疗，由于病情恶化，在妊娠23周时进行了剖宫产。分娩后，患者病情有所改善，尽管住院期间曾发生心脏骤停。患者出院时诊断为自身免疫性肝炎与原发性胆管炎重叠综合征或妊娠期肝内胆汁淤积症过程中的急性肝衰竭。产后6周随访未发现异常。尽管进行了详细的病例分析，但仍未明确最终诊断，这给未来妊娠的规划带来了复杂性。孕期可出现多种肝脏疾病，包括妊娠期肝内胆汁淤积症、原发性胆汁性胆管炎和自身免疫性肝炎。由于症状重叠以及孕期可能影响肝脏疾病进程的代谢和免疫适应，诊断这些疾病具有挑战性。快速干预对于保护母婴健康至关重要。总之，本文旨在提高对孕期急性肝衰竭相关复杂性的认识，强调诊断挑战以及及时医疗干预对母婴健康的重要性。本文旨在全面概述孕期急性肝衰竭的复杂性，旨在增进对该病症的理解、诊断和管理。
