Xiyu Pan,1 Ran Chu,2 Xu Qiao,3 Xianru Zhang,3 Li Li,1 Wenxia Zhang1 

1Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China; 2Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, People’s Republic of China; 3Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong Province, People’s Republic of China

Correspondence: Li Li; Wenxia Zhang, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, 250012, People’s Republic of China, Tel +8615153187102 ; +8615165113326, Email bzlily@163.com; WxZhangpxy@163.com

Purpose: To investigate the rare obstetric emergency with no specific treatments called acute fatty liver of pregnancy. The primary objective was to evaluate association of adverse perinatal outcomes with blood components transfusion. While the secondary objective focused on further establishing the predictive risk factors for adverse perinatal outcomes.
Participants and Methods: This retrospective cohort study included patients, who diagnosed with acute fatty liver of pregnancy without hepatic/malignant diseases in Qilu Hospital of Shandong University over 12-year period (collected 2007– 2019, aged 20– 41years). Chi-square test was used to explore the relevance between blood transfusion therapy and adverse perinatal outcomes. Meanwhile, logistic regression analysis was performed to identify predictive risk factors.
Results: Of 146 patients, 26 (26/146, 17.8%) received prenatal blood transfusions. These patients had reduced gestational ages and exhibited more severe clinical symptoms. The association between blood transfusion and adverse maternal outcomes yielded a P value of 0.044, while the association with fetal outcomes was highly significant (P< 0.001). Multivariate logistic regression analysis identified seven high-risk factors for maternal outcomes and six for fetal outcomes, all demonstrating strong discriminatory capacity.
Conclusion: Blood component transfusion may serve as a marker of disease severity. Prompt identification of patients with high-risk factors is crucial to improve maternal and fetal outcomes.
Plain Language Summary: This retrospective study evaluated 146 patients with acute fatty liver of pregnancy and 172 fetuses to determine the effectiveness of blood transfusion therapy and identify predictive risk factors for adverse outcomes. Dr. Li’s and Zhang’s team found that patients who received blood transfusions exhibited more severe symptoms. Seven high-risk factors for maternal outcomes and six for fetal outcomes were identified. Blood transfusion therapy may act as an early indicator of disease severity, requiring immediate intervention for both mothers and fetuses with high-risk factors.

Keywords: maternal-fetal medicine, blood transfusion therapy, adverse maternal and fetal outcomes, predictive risk factors