Liver failure in pregnancy: a review of 25 cases

Abstract

We retrospectively reviewed the medical records from 25 pregnant women with liver failure from May 2009 to July 2019. Data describing clinical symptoms and manifestations, routine blood analyses, coagulation, and liver and kidney function were extracted. Swansea criteria were assessed to identify variables with prognostic significance for maternal mortality. The results showed that acute fatty liver was the primary cause of liver failure and 8 (88.89%) patients died within 7 days. Swansea diagnostic criteria for assessing the severity of liver failure were consistent with Chinese guidelines and were more systematic and convenient. The incidence of postpartum haemorrhage was 76%, and the velocity of bleeding was approximately 600 mL per hour. Increased Swansea score, hepatic encephalopathy and decreased PWR were important prognostic indicators for mortality. Recovery during the 7 days postpartum period was an important determinant of maternal outcomes.

Impact statement

• What is already known on this subject? Liver failure in pregnant women is a rare but potentially devastating disease with a high rate of short-term morbidity and mortality. There are limited reports about clinical predictors of maternal–foetal outcomes and the dilemmas faced in the term of delivery.

• What the results of this study add? The incidence of postpartum haemorrhage was 76% in pregnant women with liver failure, but the velocity of bleeding was approximately 600 mL per hour. Our study revealed the Swansea score and the ratio of hepatic encephalopathy were significantly higher and platelet-to-white blood cell ratio (PWR) was lower in women who died compared to those who survived. During treatment period, 8 (88.89%) patients died within 7 days.

• What the implications are of these findings for clinical practice and/or further research? Swansea score, hepatic encephalopathy and PWR were important prognostic indicators for mortality in pregnant women with liver failure. Recovery during the 7 days postpartum period was an important determinant of maternal outcomes. Our findings may prompt researchers to conduct a large multicentre study to evaluate the prognostic indicators for mortality in pregnant women with liver failure.

Keywords:

• Pregnancy
• liver failure
• acute fatty liver; ·postpartum haemorrhage
• platelet-to-white blood cell ratio (PWR)

Acknowledgements

The authors are indebted to all participants for their support and cooperation.

Author contributions

Ying Chen: project administration, methodology, writing – review and editing. Mengyao Luo and Lei Gao: writing – original draft, data curation, formal analysis, review and editing. Junqi Niu: conceptualisation and review. Chen Chen and He Wang: data curation and prepared figures.

Disclosure statement

All authors declare that they have no conflict of interest on publishing this study.

Additional information

Funding

This work was funded by the Natural Science and Technology Major Project [2014ZX09303303], Special Fund of the First Hospital of Jilin University [JDYYZX2015007] and Jilin Province Science Development Plan [20190304125YY].