Treatment of fatty liver of pregnancy

Many expectant mothers are happily preparing to welcome the arrival of a new life, but they are susceptible to fatty liver during pregnancy, so when many changes occur in the body, they always feel panicked and at a loss. Fatty liver during pregnancy is mainly caused by the fact that we do not pay attention to our diet in our lives. Today we will take a look at how to treat it if it occurs.

Acute fatty liver of pregnancy, also known as obstetric acute pseudoyellow hepatic atrophy, is a rare and fatal disease unique to late pregnancy. The disease has an acute onset and rapidly changes in condition, and the clinical manifestations are similar to fulminant hepatitis. Previous literature has reported maternal and infant mortality rates of 75% and 85%, respectively. However, early diagnosis, early treatment, and timely termination of pregnancy can reduce the maternal mortality rate and the infant mortality rate to 58.3%.

The early or late treatment period is closely related to the prognosis of this disease. Conservative treatment has a very high maternal and infant mortality rate, and liver puncture should be performed as early as possible to confirm the diagnosis. Liver puncture is dangerous and should not be performed when there is bleeding tendency after organ failure. After the diagnosis is confirmed, delivery should be carried out promptly and maximum supportive treatment should be given.

1. General treatment: bed rest, low-fat, low-protein, high-carbohydrate diet, ensuring sufficient calories, intravenous glucose drip to correct hypoglycemia; pay attention to water and electrolyte balance, and correct acidosis.

2. Blood exchange or plasma exchange A patient with AFLP multiple organ failure was successfully treated abroad by using blood exchange with 3 times the blood volume combined with hemodialysis. Plasma exchange therapy can remove irritating factors in the blood, supplement the coagulation factors that are lacking in the body, reduce platelet aggregation, and promote vascular endothelial repair. This treatment method is widely used abroad and has achieved good results.

3. Component transfusion of large amounts of frozen fresh plasma can achieve similar effects to plasma exchange therapy. Red blood cells, platelets, human albumin, fresh blood, etc. can be given according to the situation.

4. Liver protection treatment: Vitamin C, branched-chain amino acids (hexavalent amino acids), adenosine triphosphate (ATP), coenzyme A, etc.

5. Adrenal cortical hormones are used in the short term to protect the renal tubular epithelium. It is advisable to use hydrocortisone 200-300 mg intravenously per day.

6. Others: Anticoagulants and H2 receptor blockers may be used according to the condition to maintain gastric pH>5 and prevent stress ulcers. When diuresis is ineffective for renal failure, dialysis therapy, artificial kidney, etc. can be used for treatment. Use antibiotics that have little effect on liver function, such as ampicillin 6-8g/d, to prevent and treat infection.

7. Obstetric management Once AFLP is confirmed or highly suspected, the pregnancy should be terminated as soon as possible regardless of the severity of the disease or the early onset of the disease. The reasons are as follows:

(1) The disease can rapidly worsen and endanger the life of the mother and fetus.

(2) There is no precedent for prenatal recovery of AFLP. The liver function of most patients improves rapidly after delivery and only begins to improve after delivery. Immediate delivery has resulted in a significant increase in maternal and fetal survival rates.

(3) The disease occurs near full term, and delivery has little effect on the fetus. When AFLP cannot be differentiated from fulminant hepatitis, early termination of pregnancy can improve the prognosis of the former without worsening the prognosis of the latter.

There is no consensus on whether to terminate pregnancy by cesarean section or vaginal delivery. It is generally believed that for those with poor cervical conditions or abnormal fetal position, cesarean section is often used in order to deliver the baby quickly. Local anesthesia or epidural anesthesia is used during the operation, and general anesthesia is not used to avoid aggravating liver damage. If the fetus dies in utero, the cervical condition is poor, and vaginal delivery is not possible in the short term, cesarean section should be performed. If there is a coagulation disorder during cesarean section and bleeding does not stop and conservative treatment such as uterotonics is ineffective, a subtotal hysterectomy should be performed. Sedatives and analgesics are prohibited after surgery. If conditions permit and the placenta functions well, the results of induced vaginal delivery are also good.

Supportive therapy is still required after delivery, and broad-spectrum antibiotics should be used to prevent infection. Pay attention to rest and avoid breastfeeding. After the above treatment, the condition of most mothers improved and the prognosis was good. Liver damage can usually be recovered within 4 weeks after delivery, and there are no sequelae of chronic liver disease. For a small number of patients whose condition continues to deteriorate despite rapid termination of pregnancy and the above-mentioned treatment methods, liver transplantation may be considered. Literature reports that liver transplantation can indeed improve the survival rate of patients with irreversible liver failure.

The article introduces the treatment methods of fatty liver during pregnancy in detail. I hope you can understand it well in your life. There will be great crises before and after delivery, but our mothers give everything for us without hesitation and without complaints. However, if fatty liver of pregnancy is diagnosed, there is no need to worry too much. You should pay attention to rest and receive treatment according to the doctor's instructions. I hope all mothers are healthy.