Acute yellow atrophy of the liver in pregnancy. A paper

Abstract

The acute yellow atrophy of the liver in pregnancy, fortunately, is far from being a common disease. According to Späth, it occurs in the proportion of one in 16,502. Carl Braun observed it once in twenty-eight thousand women. I had the opportunity of attending a case when I was attached to the Rotunda Hospital in Dublin, and which I am allowed to publish by kind permission of Dr. W. J. Smyly, Master of that Institution.

A IV-para, aged 27, in the eighth month of pregnancy, gave the history of gastric disturbance since two weeks, lately followed by rigor, pain in the back and head, and slight jaundice. On the first of January, when I first called, she was in labour, the foetus in the transverse lie, the cord presenting but pulseless, and no foetal heart beating. The parturient canal offering no particular resistance, I turned and delivered at once. The liquor amni was deeply yellow in colour, the child icteric and dead but not decomposed, no haemorrhage followed. This last fact seems in accordance with the results of experiments made by De Schiff, Budge, Kuhne, Hoppe, and others, who all arrived at the conclusion that the labour in Acute Yellow Atrophy of the Liver is due to the action of the biliary salts in the blood on the muscular contractility of the uterus, which determines the expulsion of the ovum and guarantees against post partum hremorrhage, the occurrence of which is not very uncommon in otherwise normal labours. [Excerpt]