11 Aug 2016
Caesarean delivery appears to be linked to better pregnancy outcomes in acute fatty liver of pregnancy (AFLP) compared with vaginal delivery, according to a meta-analysis of 80 studies.
“In cases of AFLP where the condition is identified, the termination of pregnancy is the only treatment available to achieve the most desirable outcomes for both the mother and foetus. However, the guidelines for selecting the delivery mode among women with AFLP are lacking,” the investigators said.
“At present, most doctors prefer to choose caesarean section (C-section) for AFLP patients based on their clinical experience rather than a further assessment of the risks.”
To evaluate the effect of C-section versus vaginal delivery on the maternal and perinatal outcomes, the investigators pooled data from studies involving 1,350 women with AFLP (mean age 25.2 years; mean gestational age 36 weeks; mean AFLP-to-delivery interval 8.14 days). Primary endpoints were maternal, perinatal, and neonatal mortality. Secondary endpoints included liver failure-associated complications, other organ injuries, obstetric haemorrhage, and infection.
C-section was associated with lower maternal and perinatal mortality risks compared with vaginal delivery (relative risk [RR], 0.56; 0.41 to 0.76; and RR, 0.52; 0.38 to 0.71, respectively). Meanwhile, neonatal mortality risk varied between the two delivery methods. [Sci Rep 2016;6:28826]
Complications and injuries—including disseminated intravascular coagulation, hypoglycaemia, ascites, encephalopathy, renal insufficiency, pancreatitis, and multiple organ dysfunction syndrome—as well as obstetric haemorrhage and infection did not differ significantly between C-section and vaginal delivery.
The protective effect of C-section on maternal mortality is multifactorial, the investigators said.
“The reduction in the risk may be associated with the maternal physical features since the differences in body size and pelvic structure will give rise to the different obstetrical indications and results of delivery mode in patients with AFLP. It may also be related to the severity of AFLP, as caesarean section may be more appropriate to terminate pregnancy in more severe cases,” they explained.
They also cited medical factors such as longer interval prior to delivery as a possible contributing factor to the increased mortality risk among women with AFLP.
“[B]ased on current evidence, caesarean section is the safest method of delivery and should be recommended to lower the risk of adverse pregnancy outcomes in AFLP. Nevertheless, additional optimally designed studies that consider the possible confounding factors could eventually provide a better, comprehensive understanding of the association between perinatal mortality and the mode of pregnancy termination in AFLP,” they concluded.