"Dr. Zhang, I have been pregnant for 38 weeks now. In recent days, I always feel nausea and vomiting. I look a little yellow when I look at my face?" What is going on? "
Is there an early pregnancy reaction in the third trimester?Zhang Jinyun, chief physician of the obstetrics department of the People’s Hospital of the Qingyuan City, reminded that there are symptoms such as nausea, vomiting, and jaundice in the third trimester. If the results of the blood test show poor coagulation function, liver and renal insufficiency, etc., it is highly suspected that it is acute fatty liver for pregnancy.She emphasized that although the disease rate of the disease is low, the rapids of the disease and the rapid changes in the condition are more common in the first maternal who is in the late pregnancy. Once diagnosed or highly doubt, the pregnancy should be terminated as soon as possible, otherwise it will endanger mother’s life.
Low incidence but progress quickly
"Not long ago, our departments received several cases." Zhang Jinyun said, Xiao Lan (a pseudonym), who was 36+4 weeks at the age of 27, transferred from the outer hospital.When she was admitted to the hospital, her skin and mucous membranes were mildly yellow, and the liver area was positive. It was highly suspected that she was acute fatty liver for pregnancy. At the same time, the test results showed that the patient’s coagulation function was poor.
Zhang Jinyun introduced that pregnancy acute fatty liver is the most common disease in pregnancy that leads to acute liver failure. The incidence rate is low, but the disease is rapid, the disease is rapid and dangerous.
"The pathological characteristics of the disease are that hepatocytes are infiltrated in a large amount of microcysts in the liver cells in a short time." Zhang Jinyun explained that the exact mechanism of acute fatty liver disease in pregnancy is unknown.In the cycle, the toxic effect of the liver has toxicity, causing liver cell damage and fat degeneration, and the symptoms of digestive tract, and then jaundice, hypoglycemia, coagulation dysfunction, liver and kidney dysfunction, etc.Edema, conscious disorders, hepatic encephalopathy and other utensils are incomplete.Fetal distress or even death can occur.
After Xiao Lan was admitted to the hospital, Zhang Jinyun and the medical team quickly improved pre -surgery preparations, immediately performed a cesarean section, and successfully took out a baby during the operation.Due to the patient’s coagulation dysfunction, he was transferred to the ICU monitoring treatment for 1 day after surgery; 10 days after the operation, Xiao Lan resumed well and was discharged.
The primary task is to terminate pregnancy
In addition to the high -risk factors mentioned earlier, the risk factors of acute fatty liver in pregnancy are also as follows: first maternal, multi -fetal pregnancy, male fetus, and suffering from other pregnancy liver diseases, previous history of pregnancy acute fatty liver disease, etc.Essence
"It often appears in the late pregnancy." Zhang Jinyun introduced that this is a rare disease that seriously affects maternal diseases and is deadlier. It is also the most common disease that causes acute liver failure during pregnancy.Under normal circumstances, the disease occurs mostly at 35-36 weeks, and pregnant women with hypertension and multi -fetal dysentery during pregnancy.
Acute fatty liver of pregnancy is mainly manifested as persistent gastrointestinal symptoms, such as nausea, vomiting, and can be accompanied by different degrees of anorexia, fatigue, upper abdominal pain, etc. Clinical symptoms and signs lack specificity.Relatively difficult, the condition continues to affect multi -organ systems.If you do not confirm the diagnosis in time and treat it as soon as possible, the dysfunction of multiple organs can be caused by concretion of multiple organs, and the intravascular coagulation of the vascular vascular can endanger the life of pregnant women and fetuses.
There are many complications of acute fatty liver in pregnancy. The more common and life -threatening situations in postpartum include postpartum bleeding, acute liver failure accompanied by encephalopathy, diffuse blood vessels, acute renal failure, and gastrointestinal bleeding.
"The primary task is to terminate pregnancy and ending pregnancy as soon as possible is the key to improving the prognosis." Zhang Jinyun said that once the diagnosis or high doubt, whether the condition is serious and sooner or later, the pregnancy should be terminated as soon as possible.She suggested that patients with acute fatty liver in the third trimester should not give birth to a cesarean section as soon as possible if the coagulation function is improved in vaginal delivery in a short period of time to avoid affecting the fetus.
In the past, literature reported that the mortality rate of acute fatty liver and baby in pregnancy is as high as 85%, but if early diagnosis, early treatment, and termination of pregnancy can be significantly reduced, the mothers’ mortality is significantly reduced.In the past 10 years, the prognosis of the disease has been significantly improved. The survival rate of maternal maternals is as high as 65%-90%, and the mortality rate of siege infants has fallen to 14%-18%.
"Generally speaking, timely treatment will not leave sequelae." Zhang Jinyun said that the time required for complete recovery depends on the severity of the disease.Although the disease increases the risk of complications and extend the hospitalization time of intensive care unit, timely and appropriate treatment, the patient’s condition can be significantly improved within 1-4 weeks.
Because the disease is related to pregnancy, and the liver is a organs with strong regeneration ability. In most cases, after timely termination of pregnancy and maximum support treatment, the symptoms caused by acute fatty liver will gradually alleviate, but occasionally it may continueA few weeks.However, if patients with acute fatty liver in pregnancy occur if the outbreak liver failure or even irreversible period, even if the application of artificial liver has briefly replaced liver function, it cannot save patients’ lives, which emphasizes the importance of early diagnosis and early treatment.
Maternal inspection cannot be ignored on liver and kidney examination
Pregnancy fatty liver has a great impact on maternal safety, but its cause and pathogenesis are unknown. It is recommended that pregnant women prevent it from the perspective of diet and lifestyle.
The diet is mainly light, balances various nutrients, eat more fresh vegetables and fruits, and can also eat more foods containing cellulose, reduce foods with meat, sweets, and high fat.It should not be too high.
For obese or overweight pregnant women, pay attention to control or reduce weight. Under the condition of physical conditions, it can consume accumulated energy by moving exercise to promote nutritional absorption and accelerate the body’s metabolic cycle.
Every day, there is adequate and high -quality sleep, learn to release your own pressure, you should usually pay attention to rest, do not overwork, and maintain a relaxed and happy mood.This is conducive to improving physical immunity and avoiding endocrine disorders.
Zhang Jinyun said that in general, pregnant women are relatively rare for fatty liver during pregnancy, but pregnant women cannot ignore liver and kidney examinations in normal production examinations.If nausea, general weakness, jaundice and other symptoms occur after 28 weeks of pregnancy, be sure to check in time.Once the pregnancy acute fatty liver is suspected, it must be paid enough attention and go to the hospital for treatment in time.
How to distinguish fatty liver caused by obesity
And pregnancy acute fatty liver?
Although fatty liver is a common changes in the rationality of liver disease, it seriously threatens everyone’s health.Many people have found fatty liver during physical examination, but they are often not valued.For the group of pregnant women, if there is a fatty liver, you must pay attention to it, especially the death rate of the acute fatty liver to the mother and the fetus.
What is the difference between fatty liver caused by obesity and pregnancy acute fatty liver?Many pregnant mothers are also in the mist in the clouds, and they can’t touch their heads.
The fatty liver of obese pregnant women is caused by excessive fat intake and excessive accumulation.The acute fatty liver of pregnancy can be regarded as a fat deposit caused by the abnormal fat of fat metabolism for fat metabolism.Life is safe.
The fatty liver caused by pure obesity is still different from the acute fatty liver of pregnancy. The biggest feature of the two is the difference in the level of transaminase levels. The former will maintain normal or mild increase, and the latter will rise rapidly.
Transaminase is a indicator of liver health. This substance exists in liver cells. If hepatocytes are damaged, transaminase in liver cells will enter the blood, and serum rotor aminase will be significantly higher than normal.
Therefore, fatty liver during pregnancy must be strictly controlled.Some complications caused by pregnancy fatty liver, such as embolism, can affect the growth of children, it is best to go to the hospital for examination of liver and kidney function to see if there is a bad change.During pregnancy, fatty liver caused a high mortality rate for fetal and pregnant women. Therefore, when severe fatty liver is found, pregnancy is generally recommended to avoid life risks.(Peng Keming He Jinghong Qingyi Xuan Xuan Chen Zhiyu Liu Qiuyi)
Source: Southern Daily