Abnormal Liver Function Tests as Predictors of Adverse Maternal Outcomes in Women With Preeclampsia

Kozic, Jennifer R.; Benton, Samantha J.; Hutcheon, Jennifer A.; Payne, Beth; Magee, Laura A.; Dadelszen, Peter von

doi:10.1016/s1701-2163(16)35048-4

Cited by 67 publications

(43 citation statements)

References 24 publications

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“…These findings were in accordance with a study done by Qublan et al [13] and Kozic et al [14]. They concluded that serum LDH can be a useful marker for the prediction of adverse outcome of pregnancy in severe preeclampsia.…”

Section: Discussionsupporting

confidence: 93%

Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman

Gandhi¹,

Chavda²,

Saini³

2015

Int Jour of Biomed Res

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Aims & Objectives: Our aim is to compare the serum levels of Lactate dehydrogenase (LDH) and Uric Acid in hypertensive versus normotensive pregnant woman and correlate their levels with the severity of the disease. Material & Methods: 25 antenatal patients having hypertension (Group A) & equal no. of normotensive patients (Group B) were chosen. Three readings of blood pressure were recorded after 5 minutes rest, the interval between the measurements and the average value was recorded. About 3 ml of blood was drawn under aseptic precautions from selected subjects in a plain vial for serum. Serum was separated by centrifugation and used for estimation of serum levels of LDH and UA. Observation & Results: Demographic parameters and baseline values were nonsignificant between two groups. We have observed significant difference in serum LDH and Uric acid in hypertensive group patients in comparison with normotensive patients. Conclusion: We conclude that serum LDH and Serum Uric acid are reliable and inexpensive markers to predict severity and outcome of hypertensive disorders of pregnancy

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Section: Discussionsupporting

confidence: 93%

Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman

Gandhi¹,

Chavda²,

Saini³

2015

Int Jour of Biomed Res

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“…Liver tests cannot exclusively be used to gauge clinical decisions, as the presence of normal liver enzymes does not exclude disease ( 53,54 ). An expectant approach is advised until aft er 34 weeks gestation to limit fetal morbidity ( 55 ).…”

Section: Preeclampsia and Eclampsiamentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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“…The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results [11].…”

Section: Discussionmentioning

confidence: 85%

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

Agrawal

Maitra

2015

J Obstet Gynecol India

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Background This study was conducted to evaluate how the preeclampsia integrated estimate of risk (fullPIERS) model performs in the prediction of adverse maternal outcomes when the predictor variables are all obtained within 24-h of admission for preeclampsia. Methods A prospective cohort study on 323 women who fulfilled definite inclusion and exclusion criteria was conducted. Subjects were monitored for clinical symptoms of preeclampsia, biochemical parameters, and adverse maternal and neonatal outcomes. A risk prediction score was calculated using the fullPIERS calculator. Statistical analysis of rates and ratios was carried out by assessing v 2 test and odds ratio. Results 18.3 % (n = 60) had adverse maternal outcome and 42.8 % (n = 138) had adverse fetal outcome, and 43 (13.35 %) had combined adverse maternal and perinatal outcome. Dyspnea, visual disturbances, epigastric pain, and Sp O 2 appeared to be highly significant risk factors. In the biochemical variables studied, serum creatinine and serum uric acid were found to have a significant association. The association between adverse perinatal outcome and vaginal delivery was highly significant (OR 0.35, 95 % CI 0.19, 0.63), and the P value was 0.0005. The likelihood ratio associated with the highest risk group (predicted probability of the outcome C30 %) showed excellent performance (i.e., 17.5) of fullPIERS model as a rule in test.Shruti Agrawal is a Third-Year Resident; Nandita Maitra is a Professor and Head. 123 Conclusion The fullPIERS model performed well in the prediction of adverse maternal outcomes in women with preeclampsia. It is easy to use. The model is based on the use of few important clinical and biochemical parameters and does not require extensive laboratory testing. Although it might be of limited use in a well-equipped tertiary care facility, this model can be utilized in the setting of district or sub-district level hospitals to identify patients who are at risk of complications due to preeclampsia. Timely referral to a higher center will help in reducing the morbidity and mortality associated with this condition.

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Abnormal Liver Function Tests as Predictors of Adverse Maternal Outcomes in Women With Preeclampsia

Cited by 67 publications

References 24 publications

Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman

Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman

ACG Clinical Guideline: Liver Disease and Pregnancy

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

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