RESUMO
OBJECTIVES: To study the incidence, presentation, and outcome of patients with severe liver disease in an urban Indian population. METHOD: 26 patients with severe liver disease were identified in the study period of one year at a teaching tertiary care institute in Mumbai. Investigations included bedside Bleeding and Clotting Time (BT/CT), coagulation profiles and liver and renal function tests. Management was directed towards initial stabilization followed by early delivery in an intensive care setting. RESULT: 80.71% of the patients had HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. The remaining were cases of acute fulminant hepatitis and acute fatty liver of pregnancy. The most consistent finding was thrombocytopenia (88.46%). Disseminated Intravascular Coagulopathy (DIC) was the most common complication (65%). BT/CT were 100% sensitive for the diagnosis of DIC. Maternal and perinatal mortality were 42.3% and 61.5% respectively. CONCLUSION: Intensive care facilities and an early diagnosis are essential for the management of mothers with severe liver disease. Prognosis is poor for patients with fulminant hepatitis and acute fatty liver. Screening for DIC is a must. Delay in recovery of biochemical parameters may indicate atypical disease. Patient education is essential at discharge.
Assuntos
Hepatopatias/epidemiologia , Hepatopatias/fisiopatologia , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Feminino , Morte Fetal/epidemiologia , Idade Gestacional , Humanos , Incidência , Índia/epidemiologia , Recém-Nascido , Unidades de Terapia Intensiva/estatística & dados numéricos , Hepatopatias/terapia , Mortalidade Materna , Gravidez , Complicações na Gravidez/terapia , População Urbana/estatística & dados numéricosRESUMO
Sixty-one patients with anovulation as a cause of infertility were selected for our study. Various ovulation-inducing drugs were used like clomiphene citrate, human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), bromergocryptine and leptadene. The response of the different drugs was observed by serial sonography for ovulation. Indeed there was a good response to clomiphene citrate, but those patients who failed to respond to clomiphene citrate and were frustrated with the use of hMG and hCG due to the cost and the complications of the therapy were put on Aloe compound and leptadene - an ayurvedic drug which enhances fertility in different ways.