目的:肝梗死是一种罕见的妊娠并发症,最常伴有溶血,肝酶升高,低血小板(HELLP)综合征。这项审查的目的是确定风险因素,出现体征和症状,诊断方法,以及基于已发布案例审查的最佳管理实践。
方法:搜索PUBMED和MEDLINE:OVID数据库,查找自数据库开始至2023年12月18日研究日期的妊娠或产后期有关肝梗塞的引文。关键词包括“肝梗死”或“肝梗死,\"和\"怀孕\"或\"产科。\"
方法:包括以英语发表的案例评论或案例系列。我们的研究已在PROSPERO(#CRD42023488176)注册,并根据已发布的PROSPERO和MOOSE指南进行。
方法:使用Murad等人(2018年)先前发表的工具对纳入的论文进行偏倚评估。
结果:共38篇引文记录了1979-2023年间发表的50例怀孕。其中,34%有高血压病史,26%患有抗磷脂综合征(APS),22%有血栓史。在那些没有APS诊断的人中,24%在住院期间检测阳性。大多数患者表现为上腹部或右上腹疼痛(78%),32%和16%有严重的血压(BP)或轻度BP,分别。64%的患者出现转氨酶。46%的患者早产,32%的妊娠以宫内胎儿死亡告终,流产,或为了产妇的利益而提前终止妊娠。58%的病例采用CT扫描明确诊断为肝梗死,MRI占14%,和6%的超声。在描述管理的情况下,治疗总是多模式的,包括抗高血压药(18%),治疗性抗凝(45%),输血(36%),血浆置换或静脉注射免疫球蛋白(20%),类固醇(39%)。20%的病例需要转移到重症监护病房。
结论:在所有HELLP病例中均应考虑肝梗死,但特别是在有APS病史的患者中,表现为上腹部或右上腹疼痛。诊断通常可以通过单独的CT扫描来确认。管理层应该及时给予支持,治疗性抗凝,和类固醇。
OBJECTIVE: Hepatic infarction is a rare complication of pregnancy most often associated with hemolysis, elevated liver enzymes, and low platelets syndrome. The objective of this review is to identify risk factors, present signs and symptoms, identify methods of diagnosis, and identify best management practices on the basis of published case reviews.
METHODS: PubMed and MEDLINE (Ovid) databases were searched for citations regarding hepatic infarction in pregnancy or the postpartum period from database inception until the study date of December 18, 2023. Key words included \"liver infarction\" or \"hepatic infarction\" and \"pregnancy\" or \"obstetrics.\"
METHODS: Case reviews or case series published in the English language were included. Our study was registered with the Prospective Register of Systematic Reviews (registration number CRD42023488176) and was conducted in accordance with the published Prospective Register of Systematic Reviews and Meta-analyses Of Observational Studies in Epidemiology guidelines.
METHODS: Included papers were evaluated for bias using a previously published tool.
RESULTS: A total of 38 citations documenting 50 pregnancies published between 1979 and 2023 were included. Of these, 34% had a history of hypertensive disease, 26% had antiphospholipid syndrome, and 22% had a history of thrombus. Of those without a preexisting diagnosis of antiphospholipid syndrome, 24% tested positive during hospitalization. Most patients presented with epigastric or right upper quadrant pain (78%), and 32% and 16% had severe blood pressure or mild blood pressure, respectively. Sixty-four percent of patients presented with transaminitis. Forty-six percent of patients delivered preterm, and 32% of pregnancies ended in intrauterine fetal demise, abortion, or early termination of pregnancy for maternal benefit. Computed tomography scans were used to confirm diagnosis of hepatic infarction in 58% of cases, magnetic resonance imaging in 14%, and ultrasound in 6%. In cases that described management, treatment was always multimodal, including antihypertensives (18%), therapeutic anticoagulation (45%), blood product transfusion (36%), plasma exchange or intravenous immunoglobulin (20%), and steroids (39%). Transfer to the intensive care unit was required in 20% of cases.
CONCLUSIONS: Hepatic infarction should be considered in all cases of hemolysis, elevated liver enzymes, and low platelets syndrome, but specifically in patients with a history of antiphospholipid syndrome who present with epigastric or right upper quadrant pain. The diagnosis can usually be confirmed with a computed tomography scan alone, and management should be prompt with supportive care, therapeutic anticoagulation, and steroids.