Acute fatty liver of pregnancy: a case report

Abstract

Background Acute Fatty Liver of Pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. Case presentation We report a case of AM, an 18 year patient, in her first pregnancy at 35 weeks gestation who presented with nausea, vomiting and jaundice. She had a vaginal delivery following spontaneous preterm labour. A clinical diagnosis of acute fatty liver of pregnancy was made on the 3rd day post-delivery. The post-delivery course was complicated by a deterioration of clinical symptoms with worsening hepatorenal function and development of encephalopathy. The patient died 3 days after admission and the diagnosis was confirmed on post-mortem and histology. Conclusion Delay in the diagnosis is associated with morbid complications with high mortality and this case highlights the importance of a high index of suspicion of the condition in women presenting with jaundice in pregnancy.

Fatal case of acute fatty liver of pregnancy

“…HELLP syndrome, intra hepatic cholestasis of pregnancy are other differential diagnosis for acute fatty liver. 3 In our case blood pressure and platelet counts were normal. Intrahepatic cholestasis also presents in third trimester with severe pruritis and serum bilurubin levels do not usually exceed 6 mg/dl.…”

Acute Fatty Liver of Pregnancy-a Rare but Potentially Catastrophic Cause of Jaundice in Pregnancy

“…The most common finding in HELLP syndrome, which presents with a severe degree of jaundice, is pain and tenderness in the epigastric region. Our patient did not present with any abdominal pain, tenderness, or low platelet count commonly found in HELLP syndrome; hence, we ruled out HELLP syndrome [5,6]. The patient had blood pressure within normal range during the prenatal course, and urine albumin was negative but had extensive coagulopathy.…”

Acute Fatty Liver of Pregnancy

“…The definitive management of AFLP is prompt delivery of the fetus and supportive care. Improvement is usually observed in 1 to 2 days after delivery [ 4 ]. Maternal mortality rates in patients with AFLP have improved in recent decades, with global mortality now being below 10% [ 6 ].…”