Acute fatty liver of pregnancy in a Chinese Tertiary Care Center: a retrospective study

Chen, Gezi; Huang, Ke; Ji, Bingrui; Chen, Chen; Liu, Cai; Wang, Xiaojuan; Zhao, Xin

doi:10.1007/s00404-019-05259-w

Cited by 10 publications

(19 citation statements)

References 25 publications

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“…Mehrlingsschwangerschaften sind bei beiden Erkrankungen deutlich häufiger im Vergleich zu unkomplizierten Einlingsschwangerschaften: HELLP-Syndrom: 0,2 % bei Einlingsschwangerschaft, 0,9-1,4 % bei Gemini, 2,1-10,5 % bei Drillingen, Anteil an allen HELLP-Syndromen: 10,3-15,5 % (Übersicht bei [7]). Die Prävalenz von Gemini-Schwangerschaften ist bei AFL mit 7,1-28,6 % ebenfalls deutlich erhöht [7,10,12].…”

Section: Prädisponierende Faktorenunclassified

“…Prädisponierend bei AFL ist das männliche Geschlecht des Feten, welches in 70 % der Fälle nachgewiesen wurde [12]. Untergewicht (BMI < 20) gilt als prädisponierend für die AFL (Risiko um das 1,4-Fache erhöht, [10,12]), während Übergewicht mit einem erhöhten Risiko für kardiovaskuläre, metabolische und neurologische Erkrankungen im späteren Leben gerechnet werden.…”

Section: Prädisponierende Faktorenunclassified

“…In einer Studie mit 24 Patientinnen betrug die Sensitivität dieser Methode 100 %, die Spezifität 57 %, der positive prädiktive Wert 85 % und der negative prädiktive Wert 100 % [22]. Allerdings werden die Swansea-Kriterien kontrovers diskutiert [10,12,15]. Bisher fehlen überzeugende Beweise dafür, dass durch die Berücksichtigung dieser Kriterien die Diagnose AFL früher gestellt wird [15]; ca.…”

Section: Klinische Symptome Komplikationen Und Verlaufunclassified

“…Aszites ist bei AFL mit 27-38,6 % [10,12] häufiger als beim HELLP-Syndrom mit 4-11 % [2], subkapsuläre Leberhämatome beim HELLP-Syndrom (0,9-1,6 %) häufiger als bei AFL (Einzelfälle). Leberrupturen treten beim HELLP-Syndrom in ca.…”

Section: Klinische Symptome Komplikationen Und Verlaufunclassified

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HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge

Rath

Tsikouras

Stelzl

2020

Geburtshilfe Frauenheilkd

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HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 – 18%. Perinatal mortality rates are 7 – 20% and 15 – 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.

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Section: Prädisponierende Faktorenunclassified

Section: Klinische Symptome Komplikationen Und Verlaufunclassified

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HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge

Rath

Tsikouras

Stelzl

2020

Geburtshilfe Frauenheilkd

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“…Liver protection, transfusion of blood components, albumin infusion, infection control, regulation of water and electrolyte balance, and nutritional support are necessary to promote hepatocyte recovery and mitigate complications. Prenatal platelets, total protein and total bilirubin were potential predictors of postpartum recovery time [12]. Artificial liver support therapy (ALST), including blood perfusion, plasma exchange (PE), molecular adsorption recirculation system (MARS) and dual plasma molecular adsorption (DPMAS), has been used in patients with AFLP.…”

Section: Introductionmentioning

confidence: 99%

Potential predictors for prognosis and postpartum recovery time of acute fatty liver of pregnancy

Huang

Fan

et al. 2020

BMC Pregnancy Childbirth

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Background Acute fatty liver of pregnancy (AFLP) is a potentially lethal condition of pregnant women with a high mortality rate. Potential predictors related to postpartum recovery time and prognostic factors of AFLP are still unclear. This study aimed to evaluate potential predictors for prognosis and postpartum recovery time of AFLP. Methods We retrospectively analyzed the clinical data of 76 AFLP patients in our hospital from 2002 to 2017 and investigated potential predictors using univariate analysis and multivariate logistic regression analysis. Results Hepatic encephalopathy (HE) was found to be associated with prognosis in AFLP patients (P = 0.005, OR = 26.844). The postpartum recovery time analysis showed that AFLP patients with a age < 25 had the shortest recovery time, but no significant difference (P = 0.134, OR = 5.952). The postpartum recovery time of patients with liver failure (LF) was significantly prolonged compared to those without LF (P = 0.036, OR = 10.052). Cryoprecipitate, and plasma infusion showed no significant effect on prognosis or recovery time. Artificial liver support therapy (ALST) had no effect on prognosis, but it might affect postpartum recovery time with no statistical significance (P = 0.128, OR = 5.470). Conclusion HE is a potential predictor for prognosis of AFLP. LF is a potential predictor for postpartum recovery time.

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Association between platelet counts and clinical outcomes in acute fatty liver of pregnancy: A retrospective cohort study

Gao

Wang

et al. 2023

Intl J Gynecology & Obste

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ObjectivesTo investigate whether platelet counts are associated with clinical outcomes in patients with acute fatty liver of pregnancy (AFLP).MethodsWe retrospectively analyzed 140 patients with AFLP admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2010 and August 2022. In this cohort study, we used smooth curve fitting, Kaplan–Meier analysis, and multivariable logistic regression analysis to examine the independent relationship between platelet counts and 42‐day postpartum mortality in AFLP.ResultsThere were 140 patients with AFLP, of which 15 died and 53 (37.86%) had thrombocytopenia. The overall 42‐day postpartum maternal mortality was 10.7%. We observed a U‐shaped relationship between the platelet counts and 42‐day postpartum mortality. Two different slopes were observed below and above the inflection point at approximately 220 × 109/L. After adjusting for some confounders, patients with thrombocytopenia (<100 × 109/L) were found to have increased 42‐day postpartum mortality compared with middle‐tertile and highest‐tertile patients. Patients with thrombocytopenia had a higher 42‐day postpartum mortality, and higher proportions of intensive care unit admissions, postpartum hemorrhage, and multiple organ failure (P < 0.05).ConclusionsA U‐shaped association between platelet counts and 42‐day postpartum mortality was observed in patients with AFLP. Thrombocytopenia is associated with poorer adverse clinical outcomes in women with AFLP.

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Acute fatty liver of pregnancy in a Chinese Tertiary Care Center: a retrospective study

Cited by 10 publications

References 25 publications

HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge

HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge

Potential predictors for prognosis and postpartum recovery time of acute fatty liver of pregnancy

Association between platelet counts and clinical outcomes in acute fatty liver of pregnancy: A retrospective cohort study

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