Foetal Outcomes. The overall foetal mortality rate was 7% (4/60). This comprised of 4 deaths; 2 deaths occurred in foetuses from patients with HELLP syndrome, whereas 2 occurred in patients with AFLP. Three of the four foetal deaths occurred in women with twin pregnancies. The first foetal death was in a 35 year old woman who was pregnant with twins, and presented at 30 weeks gestation with HELLP syndrome complicated by a sub-capsular haematoma. An emergency caesarean section was preformed but the second twin was still born. The subsequent two foetal deaths occurred in a 30 year old woman who presented with abdominal pain at 34 weeks gestation, was diagnosed with AFLP and went into spontaneous labour 36 hours after presentation. Unfortunately both her twins were still born. She subsequently developed grade IV encephalopathy, required intubation for airway protection, but recovered with supportive medical care. The final foetal death occurred in a 28 year old women who presented with nausea, vomiting and abdominal pain at 31 weeks gestation. She was diagnosed with HELLP syndrome, which was complicated by ischaemic hepatitis secondary to placental abruption. The baby was delivered vaginally, but was still born. The women developed ascites and renal failure but recovered with supportive medical care. Interestingly foetal death was not associated with the severity of the maternal liver disease, as guided by maternal platelet count, INR, bilirubin, AST, creatinine or the presence of encephalopathy. (Table 4.5.3) This is likely due to the rapid delivery of the fetus. (90% within 24 hours) Table 4.5.3: Severity of maternal liver disease at presentation and impact on foetal survival Foetal Death (n=4) Foetal Survival (n=56) Median age at presentation 30 (28-35) 30 (21-40) Week of gestation 31 (30-34) 35 (27-40) Number encephalopathic 1 6 99 (58-116) 55 (15-225) Platelet count (150-450 cells/µL) Creatinine (45-120 mg/dL) 247 (67-262) 152 (52-396) AST (10-50 IU/L) 975 (78-5041) 307 (16-775) Bilirubin (3-20 µmol/L) 53 (30-87) 63 (9-388) Lactate (<2 mg/dl) 2.0 (0.7-2.9) 2.0 (0.8-18.0) INR (0.9-1.2) 1.06 (1.03 – 1.58) 1.40 (0.84-4.3) * Statistical significant value for Foetal death vs. Foetal survival (p<0.05). Thirteen neonates required admission to the special care baby unit for supportive care and all were subsequently discharged, with no ongoing medical sequelae. Admission to the SCBU was associated with earlier maternal gestation (34 (27-36) vs. 36 (35-42)).
