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Retrospective analysis of acute fatty liver of pregnancy: twenty-eight cases and discussion of anesthesia.
Gynecol Obstet Invest. 2013; 76(2):83-9.GO

Abstract

AIMS

To summarize the clinical features, perioperative management and maternal and neonatal outcomes of patients with acute fatty liver of pregnancy (AFLP) and to discuss the management of anesthesia in these patients.

METHODS

This study was a retrospective review over a period of 5 years and 9 months; 28 cases from the Shanghai Public Health Clinical Center were included. Records were reviewed for symptoms, signs, laboratory findings, clinical courses, perioperative management and maternal and neonatal outcomes.

RESULTS

Of the AFLP cases analyzed in the present study, 75.0% occurred in primipara and 63.3% occurred with male fetuses. Prodromic symptoms included the sudden onset of fatigue, nausea, vomiting, anorexia and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia, leukocytosis and negative urine bilirubin. There were 2 maternal deaths (7.1%) without fetal deaths. Cesarean sections were performed in 16 cases under neuraxial anesthesia and in 12 cases under general anesthesia with rapid-sequence induction.

CONCLUSION

Early diagnosis, prompt delivery and intensive supportive treatment are critical for improving the prognosis of AFLP. Anesthesia selection should be individualized and general anesthesia with rapid-sequence induction may be the best choice for patients with severe coagulopathy.

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Publisher Full Text

Authors+Show Affiliations

Zhou G
Department of Anesthesia, Zhongshan Hospital and Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
Zhang X
No affiliation info available
Ge S
No affiliation info available

MeSH

AdultAnesthesiaAnesthesia, EpiduralAnesthesia, GeneralAnesthesia, ObstetricalAnesthesia, SpinalCesarean SectionDisseminated Intravascular CoagulationFatty LiverFemaleHepatic EncephalopathyHumansHypoglycemiaHypoproteinemiaInfant, NewbornLeukocytosisMaleParityPregnancyPregnancy ComplicationsPregnancy OutcomeRenal InsufficiencyRetrospective StudiesYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23796980

Citation

Zhou, GuoXia, et al. "Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-eight Cases and Discussion of Anesthesia." Gynecologic and Obstetric Investigation, vol. 76, no. 2, 2013, pp. 83-9.
Zhou G, Zhang X, Ge S. Retrospective analysis of acute fatty liver of pregnancy: twenty-eight cases and discussion of anesthesia. Gynecol Obstet Invest. 2013;76(2):83-9.
Zhou, G., Zhang, X., & Ge, S. (2013). Retrospective analysis of acute fatty liver of pregnancy: twenty-eight cases and discussion of anesthesia. Gynecologic and Obstetric Investigation, 76(2), 83-9. https://doi.org/10.1159/000351565
Zhou G, Zhang X, Ge S. Retrospective Analysis of Acute Fatty Liver of Pregnancy: Twenty-eight Cases and Discussion of Anesthesia. Gynecol Obstet Invest. 2013;76(2):83-9. PubMed PMID: 23796980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective analysis of acute fatty liver of pregnancy: twenty-eight cases and discussion of anesthesia. AU - Zhou,GuoXia, AU - Zhang,XiaoHong, AU - Ge,ShengJin, Y1 - 2013/06/20/ PY - 2012/08/20/received PY - 2013/04/23/accepted PY - 2013/6/26/entrez PY - 2013/6/26/pubmed PY - 2014/5/13/medline SP - 83 EP - 9 JF - Gynecologic and obstetric investigation JO - Gynecol Obstet Invest VL - 76 IS - 2 N2 - AIMS: To summarize the clinical features, perioperative management and maternal and neonatal outcomes of patients with acute fatty liver of pregnancy (AFLP) and to discuss the management of anesthesia in these patients. METHODS: This study was a retrospective review over a period of 5 years and 9 months; 28 cases from the Shanghai Public Health Clinical Center were included. Records were reviewed for symptoms, signs, laboratory findings, clinical courses, perioperative management and maternal and neonatal outcomes. RESULTS: Of the AFLP cases analyzed in the present study, 75.0% occurred in primipara and 63.3% occurred with male fetuses. Prodromic symptoms included the sudden onset of fatigue, nausea, vomiting, anorexia and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia, leukocytosis and negative urine bilirubin. There were 2 maternal deaths (7.1%) without fetal deaths. Cesarean sections were performed in 16 cases under neuraxial anesthesia and in 12 cases under general anesthesia with rapid-sequence induction. CONCLUSION: Early diagnosis, prompt delivery and intensive supportive treatment are critical for improving the prognosis of AFLP. Anesthesia selection should be individualized and general anesthesia with rapid-sequence induction may be the best choice for patients with severe coagulopathy. SN - 1423-002X UR - https://www.unboundmedicine.com/medline/citation/23796980/Retrospective_analysis_of_acute_fatty_liver_of_pregnancy:_twenty_eight_cases_and_discussion_of_anesthesia_ L2 - https://www.karger.com?DOI=10.1159/000351565 DB - PRIME DP - Unbound Medicine ER -