A Rare Case of Severe Acute Fatty Liver of Pregnancy Complicated By Postpartum Preeclampsia and Sepsis

  • Tewodros Haile Gebremariam Addis Ababa University College of Health Sciences http://orcid.org/0000-0003-4704-1435
  • Abebe Mulugeta Regassa Addis Ababa university College of Health Sciences
  • Charles B Sherman Alpert Medical School at Brown University

Abstract

Acute fatty liver of pregnancy (AFLP) is an uncommon life threatening obstetric emergency associated with significant morbidity and mortality. We report a case of a 20-year-old pregnant lady who presented with nausea, vomiting, epigastric pain, and jaundice. A clinical diagnosis of acute fatty liver of pregnancy was made. AFLP and all complications were managed accordingly. This case highlights the need for early disease recognition and treatment, and the clinical and biochemical overlap between AFLP and the syndrome of hemolysis, elevated liver enzymes, and low platelet count in pregnancy (HELLP).

Author Biographies

Tewodros Haile Gebremariam, Addis Ababa University College of Health Sciences
Assistant Professor, Department of Internal Medicine
Abebe Mulugeta Regassa, Addis Ababa university College of Health Sciences
Department of Internal Medicine

References

Gregory TL, Hughes S, Coleman MA, De Silva A. Acute fatty liver of pregnancy; three cases and discussion of analgesia and anesthesia.International Journal of Obstetric Anesthesia. 2007; 16 (2):1759.

National High Blood Pressure Education Program Working Group. Report on high blood pressure in pregnancy. Am J Obstet Gynecol. 1990;163:1691-712.

Treem WR. Mitochondrial fatty acid oxidation and acute fatty liver of pregnancy.SeminGastrointest Dis 2002;13:55–66.

Castro MA, Fassett MJ, Reynolds TB, et al. Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J ObstetGynecol 1999; 181:389-95.

Usta IM, Barton JR, Amon EA, et al. Acute fatty liver of pregnancy: An experience in the diagnosis and management of fourteen cases. Am J ObstetGynecol 1994; 171:1342-7.

Reyes H, Sandoval L, Wainstein A, et al. Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients. Gut. 1994; 35(1):101-106.

Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liverdisease in pregnancy. Lancet. 2010; 375:594-605.

Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P. A prospective national study of acute fatty liver of pregnancy in the UK. Gut. 2008;57:951-6.

Castro MA, Goodwin TM, Shaw KJ, et al. isseminatedintravascular coagulation and antithrombin III depression in acute fatty liver of pregnancy.AmJObstet Gynecol. 1996;174:211.

Fesenmeier MF, Coppage KH, Lambers DS, et al. Acute fatty liver of pregnancy in 3 tertiary care centres. Am J ObstetGynaecol. 2005;192:1416-19.

Martin JN, Briery CM, Rose CH, Owem MT, Bifill JA, Files JC. Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy. J ClinApher. 2008; 23(4):138-143.

Vigil-De Gracia P, Lavergne JA. Acute fatty liver of pregnancy.International Journal Of Gynaecologyand Obstetrics. 2001; 72:193-195.

Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liver disease in pregnancy, Lancet 2010; 375:594–605.

Moldenhauer JS, O'Brien J M, Barton JR, SibaiB. Acute fatty liver of pregnancy associated with pancreatitis: A life-threatening complication. Am J ObstetGynecol 2004; 190:502–5.

Vigil-De Gracia P. Acute fatty liver and HELLP syndrome: Two distinct pregnancy disorders. Int J GynaecolObstet 2001; 73:215–20.

Pereira SP, O'Donohue J, Wendon J, Williams R. Maternal and perinatal outcome in severe

pregnancy-related liver disease. Hepatology 1997; 26:1258–62.

Hay JE. Liver disease in pregnancy.Hepatology 2008; 47:1067–76.

Published
2019-06-28