Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy
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Kei Miyakoshi
Abstract
Massive hepatic infarction associated with pregnancy is extremely rare, but is potentially fatal. A 35-year-old primigravida with mild preeclampsia developed acute right upper quadrant pain and marked elevation of liver enzymes at 26 weeks’ gestation. After emergent cesarean section, her condition was complicated by oliguric renal failure and pulmonary edema with further deterioration of hepatic function (aspartate transaminase 4339 IU/L; alanine transaminase 3489 IU/L; lactate dehydrogenase 10780 IU/L). The contrast-enhanced computed tomography revealed non-enhancing low attenuation throughout the right lobe of liver, compatible with infarction. Continuous hemodiafiltration was initiated as renal support on postpartum day one. However, excessive fluid accumulation persisted, and she developed severe edema formation in both lung and systemic body surface. To ameliorate microvascular endothelial injury, corticosteroid therapy was begun on postpartum day five. Following treatment initiation, her renal and hepatic function showed steady improvement, accompanied by drastic resolution of edema formation. She was discharged five weeks postpartum with no additional treatment, and is without sequelae six months later. Massive hepatic infarction should be considered in preeclamptic patients who present acute abdominal pain and severe hepatic dysfunction, and continuous hemodiafiltration with corticosteroid therapy may improve the maternal outcome.
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© Walter de Gruyter
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Articles in the same Issue
- Fetal membrane inflammatory cytokines: a switching mechanism between the preterm premature rupture of the membranes and preterm labor pathways
- Preeclampsia – abnormal uterine artery Doppler is related to recurrence of symptoms during the next pregnancy
- Mother-to-infant vertical transmission of transfusion transmitted virus in South China
- Evaluation of second trimester maternal serum screening for Down’s Syndrome using the Spiegelhalter-Knill-Jones (S-KJ) approach
- β2-adrenergic receptor gene polymorphisms and pregnancy outcome
- Maternal and fetal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGF BP-3, and their relationship to fetal acidosis at delivery
- Comparison of intrapartum fetal heart rate tracings in patients with neonatal seizures vs. no seizures: what are the differences?
- Computerized cardiotocography parameters in pregnant women affected by pregestational diabetes mellitus
- The effect of processing and cryopreservation on nucleated umbilical cord blood cells
- Etiology of cerebral palsy
- Characterisation of the cytokine inflammatory response in LPS stimulated full-term cord blood
- Amniotic cavity cultures, blood cultures, and surface swabs in preterm infants – useful tools for the management of early-onset sepsis?
- Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy
- The use of recombinant factor VIIa in a primigravida with Glanzmann’s thrombasthenia during delivery
- Potential harm from puncture resistant surgical gloves
