妊娠期急性脂肪肝及其临床诊疗分析

目的：探讨妊娠期急性脂肪肝（AFLP）的发病特点、诊疗方案、并发症及转归,以提高母婴存活率。方法：回顾性分析近7年在我院确诊为AFLP的14例患者的分娩方式、诊疗经过及预后。结果：14例AFLP患者1例死亡,8例产后出血,2例多脏器功能衰竭,新生儿轻度窒息1例,重度窒息2例,死胎1例。结论：AFLP早期诊断、及早终止妊娠及各科室的相互配合是十分必要的。应严密监测及调节凝血功能、肝肾功能,防止AFLP患者产后出血及多脏器功能衰竭,提高母婴存活率。     

妊娠急性脂肪肝患者的妊娠结局和随访分析

目的回顾性分析妊娠急性脂肪肝（acute fatty liver of pregnancy,AFLP）的临床特点,探讨早期诊断和治疗与妊娠结局及产后随访结局的关系。方法对5年内收治的6例AFLP患者的临床资料进行回顾性分析,并进行了1~5年的随访。结果临床表现有厌食、喜冷饮、恶心、呕吐、上腹不适、乏力及进行性加重的黄疸等。实验室检查肝转氨酶和血清胆红素升高、纤维蛋白原下降、凝血酶原时间延长。B超和CT显示脂肪肝影像。孕产妇并发症有低蛋白血症、肾功能损害、肝性脑病、低血糖等。发病至终止妊娠时间超过10d2例,其围产儿死亡,孕产妇病情危重。无孕产妇死亡病例发生。随访1～5年,产妇和存活的婴儿均健康,2例再次妊娠无再发病。结论掌握该病的临床特点,早期诊断、尽快终止妊娠及支持治疗,是提高母婴预后的关键,治愈后无远期不良结局。     

妊娠急性脂肪肝的临床诊断及治疗方法

目的 探讨妊娠急性脂肪肝的临床诊断及治疗方法。方法 对上海市公共卫生临床中心1988年1月至2007年7月收治的36例妊娠急性脂肪肝患者的临床资料进行回顾性分析。结果 （1）临床表现：36例妊娠急性脂肪肝患者均发生于妊娠晚期,有明显的临床症状（以恶心、呕吐为主）和实验室检查特征（36例患者全部出现白细胞计数、肝酶及血清总胆红素水平升高,全部出现凝血酶原时间延长及血清白蛋白水平降低）。肝脏B超的阳性检出率为57％（17／30）,肝脏CT的阳性检出率为73％（16／22）,肝脏CT的阳性检出率高于B超（P〈0．05）。（2）分娩方式：阴道分娩12例,其中产后出血发生率为42％（5／12）,孕产妇死亡率为50％（6／12）,围产儿死亡率为50％（6／12）,新生儿窒息发生率为58％（7／12）;剖宫产分娩24例,其中产后出血发生率为42％（10／24）,孕产妇死亡率为8％（2／24）,围产儿死亡率为13％（3／24）,新生儿窒息发生率为38％（9／24）。（3）剖宫产终止妊娠加内科综合支持治疗能明显降低产后出血发生率、孕产妇死亡率、围产儿死亡率、新生儿窒息发生率。剖宫产分娩的孕产妇死亡率及围产儿死亡率与阴道分娩比较,差异有统计学意义（P〈0．05）,剖官产分娩的产后出血发生率及新生儿窒息发生率与阴道分娩比较,差异无统计学意义（P〉0．05）。（4）全部死亡病例均是从发病至接受正规治疗时间超过7d的患者。结论 结合临床症状、实验窀检查特征、肝脏B超、CT检查等,力争在发病1周内明确诊断;立即剖宫产术终止妊娠、积极内科综合支持疗法是改善母儿预后的关键。     

妊娠期急性脂肪肝围产儿预后相关危险因素及预测价值

目的:探讨妊娠期急性脂肪肝(AFLP)患者围产儿预后相关危险因素及预测价值.方法:回顾分析山东省立医院收治的AFLP患者48例,通过单因素和多因素lo-gistic回归分析其围产儿死亡预测因素,并通过受试者工作特征曲线(ROC)分析预测价值.结果:单因素分析显示,白细胞计数、总胆红素、肌酐、凝血酶原时间、国际标准化比值...     

重度子痫前期终止妊娠时间对母儿预后的影响

目的探讨重度子痫前期患者终止妊娠时间对母儿预后的影响。方法回顾分析2000-01—2005—06，福建医科大学附属第一医院妇产科收治的91例重度子痫前期患者的资料，按入院确诊至终止妊娠的时间分为三组。A组：确诊后24h终止妊娠，B组：确诊后24—48h终止妊娠，C组：确诊后〉48h终止妊娠。对三组患者母儿预后进行分析。结果（1）三组患者实验室检查均提示有凝血功能及肝肾功能障碍，三组患者间终止妊娠前低蛋白血症及蛋白尿发生率比较差异有显著性意义（P〈0．05）。（2）C组患者HEUP综合征发生率低，与其他两组比较差异有显著性意义（P〈0．05）。（3）三组围生儿结局比较，C组胎儿生长受限（FGR）及早产儿发生率最高，分别是48．6％和68．6％。（4）三组间分娩方式的比较差异有显著性意义（P〈0．05），三组患者剖宫产率均高于阴道分娩率，C组剖宫产率达91．4％。结论重度予痫前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案，选择恰当的时机终止妊娠，能取得较好的母婴结局。保守治疗时应实施严密监护。     

宫角妊娠的治疗及对术后生育能力的影响分析

目的：分析比较宫角妊娠不同治疗方案的临床效果及对术后生育能力的影响。方法：对我院2012年1月-2015年12月收治的95例宫角妊娠患者进行回顾性分析,按照治疗方法将其分为5组：清宫术组（n=21）、开腹探查手术组（n=27）、腹腔镜手术组（n=33）、减胎术组（n=5）、药物治疗组（n=9）。分析比较不同治疗方案的临床效果及对术后生育能力的影响。结果：手术患者均获得成功,术后均未发生明显不良反应。开腹探查手术组的术中出血量最多,清宫术组最少,差异有统计学意义（P＜0.05）;清宫术组手术时间短于开腹探查手术组和腹腔镜组,差异有统计学意义（P＜0.05）,而腹腔镜手术组与开腹探查手术组的手术时间比较,差异无统计学意义（P＞0.05）;术后3 d人绒毛膜促性腺激素β亚单位（β-hCG）下降程度清宫术组显著优于开腹探查手术组和腹腔镜组,差异有统计学意义（P＜0.05）;术后住院时间比较,清宫术组最短,开腹探查手术组最长,差异有统计学意义（P＜0.05）。药物治疗组的9例患者中,有8例孕囊完全排出,孕囊排出时间3~5.5 h,平均（4.1±1.2）h;阴道出血时间5~8 d,平均（7.2±1.4）d;其余1例因不完全流产转行清宫术。随访至治疗后1年,除减胎术组5例成功分娩外,其余90例患者中,计划妊娠81例,再次宫内妊娠者41例,药物治疗组再妊娠率最高,开腹探查手术组最低,差异有统计学意义（P＜0.05）。结论：对于宫角妊娠应根据患者的病情,妊娠包块大小、位置及是否破裂,患者的意愿,以及医师的实践经验和手术技巧综合考虑,力求对患者创伤程度最低,对术后再生育能力影响最小。     

妊娠期急性脂肪肝9例临床分析

目的:探讨妊娠期急性脂肪肝(AFLP)的临床特点,以便早期诊断和及时治疗。方法:对近10年我院收治的9例AFLP患者的临床资料进行回顾性分析。结果:所有患者白细胞及尿酸均升高,8例纤维蛋白原降低,8例转氨酶升高,7例胆红素升高,7例空腹血糖降低,6例尿素氮升高,5例血肌酐升高,5例白蛋白降低,5例血小板降低、凝血时间延长。孕产妇治愈8例,死亡1例,死亡率为11%,11例围生儿中,存活7例,死亡4例,死亡率为36%。结论:对高危人群行产前筛查,可降低AFLP发病率;早期诊断、尽快终止妊娠和支持治疗是提高AFLP母儿预后的关键。     

妊娠期急性脂肪肝34例临床分析

目的分析妊娠期急性脂肪肝(AFLP)的发病特点、诊断要点及预后, 指导AFLP孕妇的管理。方法收集2009年1月至2019年12月首都医科大学附属北京妇产医院收治的34例AFLP孕妇的临床资料, 对其一般情况、诊断特点、治疗情况及母儿预后等进行回顾性分析。结果本院AFLP的发生率为0.022%(34/152 383), 发病年龄为(30.6±4.9)岁, 诊断孕周为(35.3±2.4)周, 多数以妊娠晚期不明原因的消化道症状为首发症状(53%, 18/34), 并伴有不同程度的肝酶水平升高。97%(33/34)采用剖宫产术终止妊娠;产前明确诊断的孕妇仅有1例经产妇阴道分娩, 其母儿预后好。5例产妇转重症监护病房, 其中2例急性肾功能衰竭, 1例消化道出血, 2例弥漫性血管内凝血, 但无孕产妇死亡。2例新生儿重度窒息。结论应重视妊娠晚期的消化道症状, 同时了解AFLP临床表现的多样性, 以早期发现;AFLP一经诊断, 尽快终止妊娠, 以改善母儿结局。     

妊娠合并急性脂肪肝的临床分析

目的为提高早期诊断和正确处理轻型妊娠急性脂肪肝(AFLP)，降低孕产妇及围生儿的死亡率。方法对1991年12月至2001年12月在我院产科住院分娩的4例AFLP患者的临床资料进行回顾性分析。结果4例患者均为初产妇，发病孕周为32—38周，单胎3例，双胎1例，入院前1—2周均有程度不一的乏力、恶心、厌食、腹泻及上腹部不适等临床表现，全部患者肝酶升高，谷丙转氨酶(ALT)升高为111—579IU／L，平均为253IU／L：天冬氨酸转氨酶(AST)升高达72—561IU／L，平均为219IU／L：血清胆红素升高在42．2—190．6umol／L，平均为93．3umol／L；伴有凝血酶时间延长、(3例较正常对照延长3倍以上)低蛋白血症、低纤维蛋白原及不同程度的出血倾向，表现为皮肤的瘀点、瘀斑、牙龈出血、呕血及伤口渗血。并发症：肝性脑病3例，DIC3例，低血糖2例，消化道出血2例。孕产妇死亡2例，病死亡率为50％，围生儿死亡3例，围生儿死亡率为60％。结论提高对AFLP的警惕及认识，根据其临床表现，结合实验室检查及B超检查，可作出早期诊断，对AFLP患者及时终止妊娠，配合积极有效的支持疗法，可大大改善AFLP的母儿预后。     

早期诊断和综合治疗妊娠期急性脂肪肝11例临床分析

目的:探讨早期诊断和综合治疗对妊娠期急性脂肪肝(AFLP)的疗效。方法:回顾性分析妊娠期急性脂肪肝11例患者的临床资料,对其临床表现、实验室检查指标、辅助检查和内科综合治疗情况进行分析。结果:11例患者均于入院后一天内作出AFLP临床诊断并立即终止妊娠,9例剖宫产,2例经阴道分娩,共分娩14例新生儿,均存活,其中2例重度窒息。AFLP患者分娩后经积极内科综合治疗,患者临床症状明显改善,总胆红素、直接胆红素均逐渐下降,血浆白蛋白升高,凝血酶原时间缩短,尿素氮和肌酐下降。均痊愈出院。结论:早期诊断、及时终止妊娠,积极进行综合治疗对于AFLP有较好效果。     

血浆置换在治疗妊娠期急性脂肪肝中的应用价值

目的探讨血浆置换在治疗妊娠期急性脂肪肝的中的应用价值。 方法对2010年1月至2013年12月中山大学附属第三医院产科收治的17例采用血浆置换治疗妊娠期急性脂肪肝患者的临床资料进行回顾性分析,分析患者治疗前后的临床症状、体征、肝肾功能、凝血等指标,以及血浆置换出现的副作用。 结果(1)患者治疗前后各项检查指标的比较：白细胞(20.2±9.1)×10⁹/L与(15.2±5.9)×10⁹/L、天冬氨酸转氨酶(304.3±312.6)U/L与(81.4±99.5)U/L、丙氨酸转氨酶(332.5±348.3)U/L与(116.7±198.9)U/L、总胆红素(130.5±113.6)μmol/L与(84.3±35.5)μmol/L、凝血酶原时间(22.5±6.3)s与(19.6±6.7)s、尿素(9.6±7.8) mmol/L与(7.6±4.2)mmol/L、尿酸(515.3±167.0)μmol/L与(380.0±219.4)μmol/L,均得到明显改善(P值均<0.05);(2)血浆置换副作用小,未出现因不良反应而终止血浆置换治疗的病例。 结论血浆置换用于治疗妊娠期急性脂肪肝具有安全、有效等特点,在及时终止妊娠后使用血浆置换可有效遏制病情的发展。     

Clinical characteristics of acute fatty liver of pregnancy in a tertiary Indonesian hospital

Acute fatty liver of pregnancy (AFLP) is a rare, often autosomal recessive disorder with a major risk for maternal and perinatal mortality and morbidity. In order to achieve a more favorable outcome, awareness of its clinical signs and symptoms and early recognition are of pivotal importance. Over a 5-year period, 18 patients were diagnosed with AFLP (one twin, 19 babies). The most common sign and symptoms were jaundice, hypoglycemia, nausea and vomiting, encephalopathy, and hypertension. Abnormal laboratory test results included elevated total/conjugated (direct) bilirubin, AST, ALT, PT, APTT, creatinine, leukocyte count, and hypoalbuminemia. Maternal and fetal mortality rate was high: 66.7% resulted in a maternal death and 57.9% in an intrauterine fetal demise (IUFD). The number of complications was found to correlate with maternal death (p?=?.042). Surviving AFLP patients had ≤3 complications, while patients with >3 complications on presentation had a high risk of maternal death (OR?=?5.0; 95% CI: 0.55–45.4). The presence of hypertension significantly increased the risk of maternal death (OR: 24.5; 95% CI: 1.1–542.8; p?=?.01). The risk of IUFD was primarily related to gestational age at delivery and birth weight. The high rate of jaundice as presenting symptom of AFLP suggests that Indonesian primary maternity care providers may often miss its important earlier signs and symptoms, in particular de novo onset of nausea and vomiting in late pregnancy.     

Acute fatty liver of pregnancy

Objective Acute fatty liver of pregnancy (AFLP) is a rare and serious entity associated with significant maternal and neonatal mortality and morbidity. We describe our experience with the clinical diagnosis, management and course patients with AFLP.Study design Medical records of patients with AFLP were reviewed over a 10-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes.Results The incidence of AFLP was 1 in 7,270 births. The mean gestational age at onset was 34.6 ± 4.9 weeks. Eight percent of the patients were multiparous with more than three pregnancies. The prodromic phase was variable; patients complained of nausea, abdominal pain, malaise, polyuria-polydipsia syndrome and headaches followed by jaundice. The laboratory results indicated coagulopathy, liver function abnormalities and hypoglycemia. Emergency cesarean section was performed in two cases. The diagnosis has been assessed by transcutaneous hepatic biopsies processed in all patients between the 4th and 15th day (8.4 ± 4.3 days). Maternal morbidity included hypoglycaemia (40%), coagulopathy (50%) encephalopathy (30%) and renal failure (40%). There were no maternal deaths but fetal mortality is high 66%.Conclusion The early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved.     

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies

Objective: The aim of our study was to investigate the predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP) with dichorionic diamniotic (DCDA) twin pregnancies.

Methods: This study was a retrospective study of women diagnosed with ICP and DCDA twin pregnancies in Chengdu’s women and children’s central hospital. These patients were subdivided into mild and severe ICP groups according to total bile acid (TBA) level. The clinical characteristics and perinatal outcomes were collected and compared between the two groups. Logistic regression analysis was developed to evaluate predictors of adverse perinatal outcomes.

Results: About 134 cases were included in the study. Eighty-four cases were in the mild ICP group, and the other 50 cases were in the severe ICP group. Level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and direct bilirubin (DBIL) in the severe ICP group were significant higher than those in the mild ICP group. The rate of delivery before 34 gestational weeks, meconium-stained amniotic fluid, and composite adverse neonatal outcome were higher in the severe ICP group than those in the mild ICP group. After adjusting for confounders, ICP onset gestational age (GA)?<30 weeks and AST >200U/l were associated with GA at delivery <34 weeks. ALP >400U/l was an independent risk factor of meconium-stained amniotic fluid. ICP onset GA <30 weeks was an independent risk factor of composite adverse neonatal outcome.

Conclusion: ICP onset GA <30 weeks, TBA >40 µmol/l, AST >200U/l, and ALP >400U/l were associated with composite adverse perinatal outcomes in ICP with DCDA twin pregnancies. For those patients with these characteristics, fetal surveillance and treatment should be enhanced.     

Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups. Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05). Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition.     

妊娠期高血压疾病并发HELLP综合征终止妊娠时机及方式的探讨

目的:探讨妊娠期高血压疾病并发溶血、肝酶升高及血小板减少综合征(HELLP综合征)终止妊娠的时机和方式对母儿的影响。方法:对我院11年来31例HELLP综合征患者的临床资料进行回顾性分析。结果:31例患者当中阴道分娩仅2例,其中1例母体产后并发DIC死亡,围生儿1例死产,1例新生儿死亡。剖宫产29例,剖宫产率93.5%,其中1例母体术后并发急性肾功能衰竭死亡,1例术后并发DIC、多器官衰竭(MOST)死亡,余27例均存活,未发现明显后遗症;围生儿31例(双胎2例),其中胎死宫内3例,死产1例,新生儿死亡4例。结论:HELLP综合征严重威胁母儿的安全,适时终止妊娠是治疗HELLP综合征极其重要的手段,终止妊娠的方式首选剖宫产;终止妊娠的时机为诊断后24~48小时,具体还应依病情的严重程度及孕周的大小作出综合判断。     

Severe liver disease in pregnancy

Objective: To determine the clinical characteristics of patients with fulminant hepatitis of pregnancy (FHP) and acute fatty liver of pregnancy (AFLP) and analyze their correlation with pregnancy outcome. Methods: Of 55 pregnant women with severe liver disease, 41 had FHP and 14 had AFLP. Results: Jaundice was the primary manifestation for both FHP and AFLP and hepatic encephalopathy was the most significant complication for both. Disseminated intravascular coagulation, albuminuria, and prothrombin activity were found to be independent risk factors of maternal mortality for both. However, the rates of preterm labor, fetal demise, and neonatal asphyxia were lower in the FHP group. Conclusion: Women with FHP or AFLP are at risk for severe complications and adverse pregnancy outcome. Since the 2 conditions are managed differently, early diagnosis is essential.