P-24 FREQUENCY AND SEVERITY OF LIVER INVOLVEMENT IN PREGNANT WOMEN ADMITTED TO AN INTENSIVE CARE UNIT WITH HYPERTENSIVE DISORDERS OF PREGNANCY

Abstract

Introduction: The hypertensive disorders of pregnancy(HDP) are major causes of maternal and perinatal morbidity-mortality worldwide. Aims: To evaluate the frequency and severity of liver involvement in pregnant women with HDP, assessing its outcomes. Methods: A total of 210 parturients were retrospectively evaluated. The frequency of any type of liver involvement was investigated, and its occurrence correlated with maternal-fetal mortality and prematurity. Results: The most common symptoms were abdominal pain (100; 47.6%) and headache (83; 39.5%). Most patients had gestational hypertension defined as severe (n = 184), including 6 (2.9%) women progressing to eclampsia. Changes in liver enzymes and HELLP syndrome were observed in 124 (59%) and 19 (9%) patients, respectively. Subcapsular hemorrhage and spontaneous hepatic rupture were identified in one woman who died. No patient had definitive diagnosis for acute fatty liver of pregnancy, neither acute liver failure. 62% of deliveries occurred before 37 weeks. Fetal mortality was observed in 6 (2.9%) cases. It was associated with gestational age (29.3±5.7 vs.34.01 ±4, p = 0.006), the occurrence of pulmonary edema (16.7% vs. 0.5%, p= 0.005) and renal insufficiency (33% vs. 5%, p= 0.04). Multiparity (68%vs, 30%, p=0.0001), previous history of hypertension (22.4 %vs 12.3 %, p=0.05), uric acid concentration (6.7±1.6 vs 5.9±1.5, p= 0.005) and renal dysfunction (7.5% vs. 1.4 % vs. p=0.05) were associated with prematurity. There was no significant correlation between prematurity or maternal-fetal mortality and liver involvement. Conclusion: HDP form a spectrum of disease. Early recognition and multidisciplinar support are essential in order to ensure better outcomes.

Keywords

• Pregnancy
• liver
• hypertensive disorders
• pre-eclampsia
• eclampsia