Late gestational liver dysfunction and its impact on pregnancy outcomes

Abstract

Objective: The aim of this study was to investigate the impacts of late gestational liver dysfunction and its impact on pregnancy outcomes. Materials and Methods: The patients hospitalized for liver dysfunction in their late pregnancy between 2010-2012 were set as the observation group, and the pregnant women with normal liver function at the same period were randomly selected and set as the control group. The impacts towards the pregnancy outcomes were compared between these two groups and the impacts of differentdegree transaminase increasing towards the pregnancy outcome were analyzed. Results: The incidence rates of cesarean section, postpartum hemorrhage, fetal distress, premature birth, premature rupture of membranes (PROM) of the observation group and the transaminase-severely-increased group (the severe group) were higher, and the differences were statistically significant (p < 0.01 or < 0.05); while only the cesarean rate of the mild and moderate group was significantly different from the control group (p < 0.01 or < 0.05). The ratios of intrahepatic cholestasis in pregnancy (ICP), gestational hypertension + HELLP syndrome, acute fatty liver in pregnancy (AFLP) of the severe group were higher than the mild and moderate group, and the differences were statistically significant; the nonalcoholic fatty liver disease (NAFLD) group and the unknown cause group mainly showed a mildly increased transaminase; the distributions of viral hepatitis in pregnancy (VHP), post-viral-hepatitis-B cirrhosis, biliary tract disease, and infected toxic liver dysfunction in different-degree increased transaminase groups had no significant difference. Conclusions: Liver dysfunction in later pregnancy, especially with severe transaminase increase, might significantly increase the risk of adverse maternal events. The major causes of severe liver dysfunction in late pregnancy were ICP, gestational hypertensive disorders, and AFLP.

Platelet count and indices as postpartum hemorrhage risk factors: a retrospective cohort study

“…9 Preeclampsia and HELLP syndrome, and HELLP syndrome severity, are established risk factors for PPH. [10][11][12][13] Moreover, the relation between thrombocytopenia in pregnancy and PPH has been studied several times, yet these studies showed mixed results, [14][15][16][17] lacked statistical power, [18][19][20][21][22] or only studied subgroups. 23,24 Furthermore, these studies mostly focused on PPH or PPH surrogates rather than the more clinically relevant outcome parameter SPPH.…”

“…Approximately 75% is due to gestational thrombocytopenia, 20% to preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, and 3%–5% to other causes 9 . Preeclampsia and HELLP syndrome, and HELLP syndrome severity, are established risk factors for PPH 10‐13 …”

“…9 Preeclampsia and HELLP syndrome, and HELLP syndrome severity, are established risk factors for PPH. 10 , 11 , 12 , 13 …”