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

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.