{
  "abstract": "Introduction Maternal mortality in the UK is at its highest in two decades, with increasing proportions of high-risk obstetric patients. A challenging cohort are those with liver pathology, which includes pre-existing liver disease, gestational specific liver disorders, and non-pregnancy related new liver pathology. This study aims to review outcomes of obstetric patients with liver pathology requiring admission to a quaternary care liver centre’s intensive care unit (ICU).Methods A retrospective single centre study of pregnant and post-natal patients identified from hepatology ICU handover archives (Jan 2014 – Dec 2023). Electronic records were reviewed collating demographics, laboratory results, and admission outcomes including maternal and foetal mortality.Results 42 patients were identified: 9 (21.4%) with pre-existing liver disease, including 2 acute on chronic liver failure (ACLF); 28 (66.7%) pregnancy specific liver pathologies; and 5 (11.9%) non-pregnancy related new liver pathologies. 29 patients were post-partum. The other 13 had median gestation of 24 weeks (range 8–38 weeks). Pre-existing liver disease included autoimmune hepatitis (AIH), cirrhosis, alcohol-related liver disease, Budd Chiari Syndrome (BCS), and various causes of non-cirrhotic portal hypertension. Pregnancy specific liver pathology included hyperemesis gravidarum with ischemic hepatitis, Acute Fatty Liver of Pregnancy (AFLP), and Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP syndrome). New onset non-pregnancy specific aetiologies included acute liver failure (ALF) secondary to paracetamol overdose, acute hepatitis B infection, herpes simplex hepatitis, and Hemophagocytic lymphohistiocytosis (HLH). Mean critical care admission was 5 days (range 1–60). 2 patients received liver transplantation—1 on the ACLF tier for decompensated AIH cirrhosis and 1 on super urgent list for ALF secondary to hepatitis B, with transplantation during pregnancy at 25+5 gestation. 6 (66.7%) patients with pre-existing liver disease presented with variceal bleed. There were 4 maternal deaths, due to HLH, ischaemic hepatitis, and 2 ACLF patients. There were 12 foetal or neonatal deaths, including 2 medical terminations of pregnancy and 1 miscarriage. There were 8 intrauterine deaths, 4 associated with HELLP, 1 due to AFLP, and 3 in patients presenting with variceal bleed. 1 baby died at 8 days old from HSV infection.Conclusions In this cohort of patients, pre-existing liver disease was associated with half of the maternal deaths and a third of foetal deaths, confirming the high-risk nature of these pregnancies. This emphasises the importance of multi-disciplinary care between obstetricians and hepatologists to ensure these patients receive pre-pregnancy counselling and antenatal monitoring.",
  "authors": [
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Charlotte Sewell"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Esme Gardiner"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Fiona Thompson"
    },
    {
      "affiliations": [
        "Birmingham Women’s Hospital, Birmingham, UK"
      ],
      "name": "Ellen Knox"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "James Ferguson"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Mansoor Bangash"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Abhishek Chauhan"
    },
    {
      "affiliations": [
        "Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Neil Rajoriya"
    }
  ],
  "title": "P143 A 10-year review of obstetric admissions to a quaternary liver critical care unit: learning from morbidity and mortality",
  "uid": "46dacbef-6794-5b58-b6e0-b59ae36f5a30"
}