Acute Fatty Liver of Pregnancy: Rare, but Potentially Fatal
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Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal disease. The pathophysiology of AFLP remains unknown, but there is some evidence of an association with fatty acid oxidation defects during pregnancy. This condition usually occurs between 30 and 38 weeks of gestation. The clinical signs are nonspecific, with the most frequent symptoms being nausea, vomiting, abdominal pain, and jaundice . This pathology remains an obstetric emergency, requiring early diagnosis and treatment, which currently consists of termination of pregnancy and supportive therapy. Disseminated intravascular coagulation (DIC) is one of the most frequent complications .

Here is the case presented in The American Journal of Case Reports of a 34-year-old, healthy woman, at 37 weeks and 2 days’ gestation, came to the Emergency Department for loss of amniotic fluid. She also referred to nausea and vomiting with 4 days of evolution, associated with prostration since that day. She denied pruritus, headache, epigastric pain, or visual impairment. Pregnancy was monitored without inter-currences. She had no history of travel or ingestion of drugs or medicinal herbs. On admission, the patient was uncooperative, icteric, apyretic, with blood pressure of 118/74 mmHg and lower-limb edema.

Abdominal ultrasonography revealed “liver with a slight increase of the right lobe, admitting a discrete diffuse heterogeneity with a slight increase in echogenicity, translating diffuse steatosis”. A presumptive diagnosis of acute fatty liver of pregnancy was made. The patient was admitted to the delivery room and, due to fetal distress, underwent an emergency cesarean section. The newborn male, weighing 2810 g, requiring resuscitation.

In the postoperative period, the patient was transferred to the Intensive Care Unit (ICU) for treatment and stabilization of acute hepatic and renal insufficiency and disseminated intravascular coagulation (DIC). She required continuous infusion of 5% dextrose for about 10 days to maintain euglycemia. On the 7th day of hospitalization, she underwent abdominal CT, which revealed “discrete globosity of the pancreatic parenchyma, with dimensions at the upper limit of normality”, and acute pancreatitis was diagnosed. She was progressively able to eat, up to the date of discharge. She presented progressive improvement of the analytical parameters of hepatic function (Table 1). Due to DIC, she underwent therapy with fresh frozen plasma, fibrinogen, and vitamin K. She was discharged, clinically improved, on the 22nd postnatal day

In summary, decreased maternal and fetal mortality are associated with early recognition of this pathology and timely action in a context of differentiated care.

Source :
Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
It is logical that all known causes ie potential causes are to be ruled out.
Mar 4, 2020Like