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.
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.