Erol Amon

Acute fatty liver of pregnancy: An experience in the diagnosis and management of fourteen cases

OBJECTIVEnOur purpose was to investigate the diagnostic problems and maternal-perinatal outcome in cases of acute fatty liver of pregnancy.nnnSTUDY DESIGNnFourteen cases with acute fatty liver of pregnancy managed during the past 8-years were studied with emphasis on presenting symptoms, admitting diagnosis, laboratory findings, clinical course, maternal complications, and neonatal outcome.nnnRESULTSnThe mean gestational age at onset was 34.5 weeks (range 28 to 39). Only seven patients had acute fatty liver of pregnancy as a definite or suspected diagnosis on admission. Computed tomography of the liver was performed on 10 patients, with only two positive results. There were no maternal deaths; however, maternal morbidity was frequent: four patients had hepatic encephalopathy, three pulmonary edema, three ascites, four respiratory arrest, two diabetes insipidus, and 10 had transfusion of blood or blood products to correct either disseminated intravascular coagulation or excessive bleeding. Coagulation abnormalities were common: hypofibrinogenemia (< 300 mg/dl) in 13 patients (93%), prolonged prothrombin time in 12 (86%), and prolonged partial thromboplastin time in 11 (79%). The corrected perinatal mortality was 6.6%.nnnCONCLUSIONnAcute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclampsia in the presence of hypoglycemia, low fibrinogen, and prolonged prothrombin time, particularly in the absence of severe abruptio placentae. Computed tomography of the liver has a high false-negative rate in patients with acute fatty liver of pregnancy. In spite of the literatures dismal prognosis, our findings indicate that maternal and perinatal outcomes appear favorable in well-managed patients.

Obstetric variables predicting survival of the immature newborn (⩽1000 gm) : A five-year experience at a single perinatal center

Abstract The immature neonate constitutes less than 3% of total births and yet accounts for almost 50% of all perinatal deaths. In a 5-year period, 476 consecutive live and inborn neonates weighing ⩽1000 gm were studied. The purpose of this study was to describe our experience with these pregnancies and determine the obstetric predictors of survival. Statistical methods of univariate and multivariate analysis were used. Survival was defined as the discharge home of an alive infant. The overall survival rate without exclusions was 40.3%. The following variables were most significant and accurately predicted survivors in 76.2% and nonsurvivors in 69.2% of cases: a combination of birth weight, 5-minute Apgar score, gestational age, cervical dilatation on admission, sex, a more recent study time interval, and race. Of the factors studied, the following were directly related to advancing gestational age and birth weight: higher Apgar scores at 1 and 5 minutes, increased operative delivery rate, and increased frequency of tocoiysis and glucocorticoid usage; of these factors, only the 5-minute Apgar score remained statistically significant, when controlling for gestational age and birth weight by multivariate analysis.

Factors responsible for preterm delivery of the immature newborn infant (≤1000 gm)

Abstract Although there are excellent studies examining factors responsible for preterm delivery in general, there is a scarcity of data describing factors specifically associated with delivery of the immature newbown infant. Our purpose is to characterize these factors in order to determine what may be done to limit preterm delivery rate of extremely low birth weight infants. Obstetric variables responsible for the birth of 338 live in-born immature neonates in a large single perinatal center were detemined. We were unable to affect 65% of these pregnancies because there was no chance for intervention prior to adminssion in 63% of these mothers, and 66% had nonpreventable obstetric complications responsible for delivery. The median time interval from admission to delivery was 7 hours. Mortality was significantly higher in those delivered within 7 hours. We also found that neonatal mortality was twice as high in infants born to women with a previous perinatal loss. The clinical implications of these results are discussed.

Quantitative analysis of amniotic fluid phospholipids in diabetic pregnant women.

&NA; Controversy exists regarding the fetal lung maturity profiles in diabetic and normal pregnancies. Diabetic and control patients at term were compared. A comprehensive lung profile was obtained using high performance liquid chromatography, lecithin:sphingomyelin ratio by conventional thin‐layer chromatography, and the Lumadex foam stability index. There was no statistically significant difference in the phospholipids measured by any of the three techniques despite the fact that the control patients had a significantly higher mean gestational age at amniocentesis. As expected, the diabetic pregnancies had a significantly higher mean birth weight. There was no case of respiratory distress syndrome in either group. The present data do not allow rejection of the null hypothesis of no difference in amniotic fluid phospholipids, between diabetic and normal pregnancy, at term. (Obstet Gynecol 68:373, 1986)