title: Acute liver failure in pregnancy: causative and prognostic factors.
abstract: OBJECTIVE
  Acute liver failure (ALF) in pregnancy is often associated with a poor prognosis. In this single-center observational study we aim to study the incidence, causes, and factors affecting mortality in pregnant women with ALF.
  
  
  METHODS
  Sixty-eight pregnant women reporting with clinical features of liver dysfunction were enrolled as "cases." Their clinical course was followed and laboratory studies were performed. The presence of ALF was defined as the appearance of encephalopathy. The results were compared with a "control" group of 16 nonpregnant women presenting with similar complaints. The cases were further subdivided into two groups of "survivors" and "nonsurvivors" and were compared to find out the factors that contribute to mortality.
  
  
  RESULTS
  ALF was seen in significantly more number of pregnant women than the controls (P = 0.0019). The mortality rate was also significantly higher (P = 0.0287). Hepatitis E virus (HEV) caused jaundice in a higher number of pregnant women (P < 0.001). It also caused ALF in majority (70.3%) of pregnant women, but HEV infection was comparable between the survivors and nonsurvivors (P = 0.0668), hence could not be correlated with mortality.
  
  
  CONCLUSIONS
  Pregnant women appear to be more susceptible for HEV infection and development of ALF. The mortality of jaundiced pregnant women increased significantly with appearance of ALF, higher bilirubin, lower platelet count, higher international normalized ratio, and spontaneous delivery.
authors: Department of Medicine, GR Medical College, Gwalior, Madhya Pradesh, India.
authors: Shweta
authors: S
authors: Sahai
authors: Ravi
authors: R
authors: Kiran
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000821:virology; D016022:Case-Control Studies; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D005260:Female; D046689:Fetal Mortality; D016751:Hepatitis E / Q000175:diagnosis / Q000821:virology; D016752:Hepatitis E virus / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007565:Jaundice / Q000821:virology; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D011379:Prognosis; D012959:Socioeconomic Factors