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Archivos de Medicina de Urgencia de México

2026, Number 1

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Arch Med Urg Mex 2026; 18 (1)

Clinical presentation, laboratory values, and therapeutic approach for postpartum patients with pregnancy-associated liver disease admitted to the Intensive Care Unit of the Gynecology and Obstetrics Hospital No. 3 at the CMN “La Raza”

Díaz-Aguilar FA, Sánchez-Gutierrez DI, Mendez de Jesus IA, Sanabria-Cordero D, Cruz-Martínez FJ, Robledo-Clemente MG

Language: Spanish
References: 40
Page: 11-25
PDF size: 404.04 Kb.


ABSTRACT

Introduction: specific and pregnancy-related liver diseases are high-risk obstetric emergencies that can progress to hemolysis, coagulopathy, renal dysfunction, and the need for intensive care. Therefore, their early recognition and stabilization are priorities in specialized centers.
Objective: we described the clinical presentation, laboratory values, and therapeutic approach used in patients with pregnancy-related liver diseases who required admission to the Adult Intensive Care Unit of Gynecology and Obstetrics Hospital No. 3 at the «La Raza» National Medical Center, during the period from July 1, 2022, to December 31, 2024.
Methodology: this was an analytical, descriptive, observational, longitudinal, and retrospective study based on a systematic review of medical records. Demographic variables, comorbidities, symptoms on admission, vital signs, complete blood count, renal function, liver profile, coagulation tests, therapeutic interventions, organ support, and discharge disposition were analyzed. Bivariate comparisons were performed using the Mann-Whitney U test.
Results: fifty-four women were included. The median age was 32.5 years (range 17–47; IQR 26.75–37.00). The median gestational age at admission to the intensive care unit was 32.35 weeks (range 22.0–38.2; IQR 28.48–35.28). HELLP syndrome was predominant in 90.7% of cases, acute fatty liver of pregnancy (AFLP) was documented in 11.1%, and subcapsular hepatic hematoma in 5.6%; these categories were not mutually exclusive. Proteinuria was present in 68.5% of cases. Admission symptoms included epigastric pain (46.3%), headache (22.2%), nausea (16.7%), and vomiting (14.8%). The median biochemical values on admission were: glucose 87.5 mg/dL (range 27.0–145.0), urea 31.0 mg/dL (range 6.0–343.0), creatinine 0.79 mg/dL (range 0.37–7.24), and platelets 72 x 10⁹/L (range 13–264). AST and ALT were elevated, with medians of 222.5 U/L and 191 U/L, respectively. Fibrinogen was 635 mg/dL (range 179–895). In the adult intensive care unit (ICU), maternal complications included acute kidney injury (33.3%), obstetric hemorrhage (14.8%), and the need for invasive mechanical ventilation (7.4%). There were no maternal deaths, and 100% of patients were discharged to the inpatient ward. Steroid use was associated with greater hemodynamic stability (p=0.03), less renal dysfunction (p=0.002), improved platelet count (p=0.045), and a shorter length of stay in the ICU (p=0.026).
Conclusions: HELLP syndrome was the leading hepatic reason for admission to the ICU. There were no maternal deaths. Corticosteroid therapy was a frequent part of multidisciplinary management and was associated with improved hemodynamic stability, reduced acute kidney injury, increased platelet count, and a shorter length of stay in the ICU.


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