Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis

Abstract

Several studies have reported a positive association between caesarean section for expeditious pregnancy termination and perinatal outcomes in acute fatty liver of pregnancy (AFLP); however, the risks remain unclear and independent studies have reported conflicting findings. In this meta-analysis, we aimed to confirm the relationship between caesarean section and perinatal outcomes in AFLP. The PubMed, Embase, and China National Knowledge Infrastructure databases were searched (until July 17, 2015) for observational clinical studies focusing on the association between caesarean section and perinatal outcomes in AFLP. Data were extracted and processed independently by 2 authors. We also compared caesarean section with vaginal delivery to further investigate this relationship. We observed that 2 of the 3 primary outcomes in caesarean section exhibited positive effects—the maternal mortality rate was 44% lower (relative risk [RR], 0.56 [0.41–0.76]) and perinatal mortality rate was also reduced (RR, 0.52 [0.38–0.71]), compared to those for vaginal delivery. We did not find any associations between caesarean section and perinatal outcomes in AFLP in terms of neonatal mortality type and maternal multiple organ complications. These findings emphasise the significant prognostic value and clinical implications of caesarean section in AFLP, and suggest that the adverse outcomes should be reduced.

Treating acute fatty liver of pregnancy with artificial liver support therapy

“…In patients in a critical condition, other severe complications can also be seen such as DIC, hepatic encephalopathy, hypoglycemia, MODS, etc. [ 18 ] Pathogenesis of AFLP is associated with acute hepatic failure subsequent to massive necrosis of hepatocytes resulting in accumulation of various toxins, reduced synthesis of essential factors, and endotoxin-induced cytokine storm. All these factors contribute to the development of multiple-organ dysfunction.…”

Pregnancy-associated liver disease: a curriculum-based review

“…A recent meta-analysis by Wang et al showed that caesarean section is the safest method of delivery and is associated with better pregnancy outcomes 7. Although treatment, in the main, is supportive, there have been reports of liver transplantation and plasma exchange postdelivery 4…”

Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study

“…AFLP remains a serious disease with high mortality from to 16.5-26.7% [4,5] due to severe complications such as DIC, renal function impairment, hepatic encephalopathy, hypoglycemia, MOF, etc. [7] Because the scarcity of AFLP [8], more comparative studies are needed about its clinical characteristics, treatment and outcomes.…”