1983 Volume 80 Issue 3 Pages 820-827
In the obstetric records of 119, 004 from 1966-1980 in Okayama city, eight patients of severe liver injury with hepatic encephalopathy were retrospectively reviewed for studying the cause and appropriate management. The incidence of severe liver injury was 0.007 per cent and all of eight cases were primigravida. In seven of eight cases, severe liver injury occurred in the latter stages of pregnancy (3rd trimester) and its mortality rate amounted to 75 per cent. In most of them, encephalopathy occurred immediately after delivery with severe bleeding tendency, and the interval from the onset to encephalopathy and also death were 3 to 10 days and 4 to 45 days, respectively. Liver histology revealed a case of acute fatty liver of pregnancy, 5 cases of acute hepatitis (severe type) with massive or submassive hepatic necrosis and two cases of toxic fatty liver. Seven of eight patients were clinically diagnosed as fulminant hepatitis acording to the recent criteria of fulminant hepatitis. However, fulminant hepatic failure would be better in two cases with severe fatty metamorphosis, because pathological findings as hepatitis were deficient. A great attention should be paid to severe liver injury during the latter stage of pregnancy and delivery.