Recombinant activated factor VII in the management of acute fatty liver of pregnancy: A case report

Abstract

A 20-year-old woman, primigravida at 36(+4) weeks' gestation presented with malaise, vomiting for 1 week, yellowish discoloration of the eyes for 3 days and loss of fetal movements. A clinical diagnosis of acute fatty liver with intrauterine fetal demise was made. Labor was induced with prostaglandin E2 gel and delivered vaginally. The post-partum period was complicated by atonic post-partum hemorrhage, an episode of seizure, recurrent hypoglycemic attack, hypokalemia and continuing coagulopathy. Supportive management in the intensive care unit using blood and blood products and injection recombinant activated factor VIIa to arrest the bleeding resulted in a successful outcome.

Acute Fatty Liver of Pregnancy: A Life-Threatening Condition Requiring a Life-Saving Approach

“…Fibrinogen and prothrombin complex concentrates were administered to the patient and the cesarean section was performed without any major bleeding (17). The injection of recombinant factor 7 along with supportive care management in an intensive care unit has been also recommended (18). Through the application of plasma exchange and plasma perfusion during the early phase of AFLP, the progression of the disease can be stopped or reversed (19).…”

“…In sum, it is important to note that the management of AFLP is a multidisciplinary progress that necessitates active and prompt intervention by gastroenterologists and anesthesiologists along with obstetricians and neonatologists in a tertiary care center equipped with an intensive care unit (9, 13, 18). While as deleterious as both preeclampsia and HELLP syndrome, AFLP differs in that its management requires more than just the termination of the pregnancy.…”