ACUTE YELLOW ATROPHY OF THE LIVER IN PREGNANCY
Acute yellow atrophy of the liver in pregnancy was formerly called
Icterus Gravis. The disease is not necessarily connected with
pregnancy, but half the cases are in pregnant women, and with them
it may appear at any time in gestation or shortly after delivery.
Pernicious vomiting, eclampsia, sepsis, chloroform poisoning,
typhoid, osteomyelitis, diphtheria, erysipelas, alcoholism, or
phosphorus poisoning in pregnant women may end in this acute yellow
atrophy. Bendig[138] reported two cases, both fatal, which were
caused by syphilis.
[138] _Münchener medizinische Wochenschrift_, August, 1915.
The liver lessens in size, is friable, yellow-streaked, mottled with
red; the heart degenerates, and all tissues are stained with bile,
icteric. If the hepatic atrophy is a consequence of the diseases
enumerated above, the symptoms of these diseases precede those of the
atrophy. In chloroform poisoning the attack may end fatally within
six hours, or it may last for five or six days before death.
If a pregnant woman has had gastric catarrh with weakness and
headache, and then suddenly becomes delirious, begins to toss about
the bed with rolling of the head from side to side, is jaundiced,
shows epigastric tenderness, and a diminution of the liver dullness,
the diagnosis is almost certain. The reflexes are exaggerated, there
are minute petechiae on the trunk, arms, and legs, the tongue is
dry and brown, the breath is foul, the pulse is fast and weak, the
temperature is usually high (102-104 degrees), and the urine shows
nephritis.
The prognosis is always bad. The fetus nearly always dies. If the
fetus is viable the uterus should be emptied at once even if the
woman is so near death that the procedure appears useless: it may at
least give a chance to baptize the infant. Suppose in a particular
case a consultant or the physician in charge holds that the mother is
so ill that therapeutic abortion will only hasten her death, yet the
fetal heart-sounds can be heard through her abdominal wall. In that
case I should be in favor of performing the abortion to baptize the
infant, reluctantly permitting the chance of hastening the mother's
death. But this hastening is by no means certain.
When a diagnosis of acute yellow atrophy has been made the patient
should receive the last sacraments as soon as possible.