ACUTE FATTY LIVER OF PREGNANCY- CASE REPORT AND REVIEW OF LITERATURE

  • Baros Alexandru UMF "CAROL DAVILA" BUCURESTI
  • Alina Potorac 1Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Bucharest, Romania
  • Natalia Turcan 1Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Bucharest, Romania
  • Diana Secara 2Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Octavian Munteanu Department of Anatomy „Carol Davila” University of Medicine and Pharmacy, Bucharest
  • Claudia Mehedintu 2Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and
  • Monica Cirstoiu 2Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and
Keywords: Keywords: acute fatty liver disease, obstetrical emergency, fatty acid metabolism, HELLP syndrome, severe preeclampsia, jaundice

Abstract

Acute fatty liver disease (AFLP) is a rare, potentially fatal complication that occurs in the third trimester of pregnancy or in the early postpartum period, being first described by Sheehan in 1940, representing an obstetrical emergency. Although the exact pathogenesis is unknown, this disease has been linked to an abnormality in fetal fatty acid metabolism, characterized by fatty microvesicular infiltration of hepatocytes without inflammation or necrosis. Although the Swansea Criteria have been developed to diagnose acute fatty liver pregnancy, there is a large clinical overlap between AFLP, HELLP syndrome and severe preeclampsia, and it is often impossible to make a clear diagnosis between them. We present the case of a 38-year-old patient, with 36-week pregnancy, biparous, after a caesarean section 7 years ago, who presented to the emergency unit, in the obstetrics-gynecology service of a multidisciplinary hospital, directed by the attending physician for severe jaundice, alcoholic stools, nausea, vomiting, epigastric pain.

Keywords: acute fatty liver disease, obstetrical emergency, fatty acid metabolism, HELLP syndrome, severe preeclampsia, jaundice

References

Bibliography
[1] E. Ziki, S. Bopoto, M. G. Madziyire, and D. Madziwa, “Acute fatty liver of pregnancy: a case report,” BMC Pregnancy and Childbirth, vol. 19, no. 1, p. 259, Jul. 2019, doi: 10.1186/s12884-019-2405-5.
[2] “Acute fatty liver of pregnancy - UpToDate.” https://www.uptodate.com/contents/acute-fatty-liver-of-pregnancy?search=acute%20fatty%20liver%20of%20pregnancy&source=search_result&selectedTitle=1~46&usage_type=default&display_rank=1#H453601875 (accessed Apr. 03, 2022).
[3] D. B. Nelson, N. P. Yost, and F. G. Cunningham, “Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery,” American Journal of Obstetrics and Gynecology, vol. 209, no. 5, p. 456.e1-456.e7, Nov. 2013, doi: 10.1016/j.ajog.2013.07.006.
[4] Y. Joueidi et al., “Maternal and neonatal outcomes and prognostic factors in acute fatty liver of pregnancy,” Eur J Obstet Gynecol Reprod Biol, vol. 252, pp. 198–205, Sep. 2020, doi: 10.1016/j.ejogrb.2020.06.052.
[5] A. M. Allen et al., “The Epidemiology of Liver Diseases Unique to Pregnancy in a US Community: A Population-Based Study,” Clin Gastroenterol Hepatol, vol. 14, no. 2, pp. 287-294.e1–2, Feb. 2016, doi: 10.1016/j.cgh.2015.08.022.
[6] D. Nelson and R. Schell, “Acute Fatty Liver of Pregnancy,” Contemporary OB/GYN Journal, vol. 66, no. 06, Jun. 2021, Accessed: Apr. 03, 2022. [Online]. Available: https://www.contemporaryobgyn.net/view/acute-fatty-liver-of-pregnancy
[7] G. Q et al., “Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study,” Singapore medical journal, vol. 59, no. 8, Aug. 2018, doi: 10.11622/smedj.2018001.
[8] T. T. Tran, J. Ahn, and N. S. Reau, “ACG Clinical Guideline: Liver Disease and Pregnancy,” Official journal of the American College of Gastroenterology | ACG, vol. 111, no. 2, pp. 176–194, Feb. 2016, doi: 10.1038/ajg.2015.430.
[9] J. A. Ibdah et al., “A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women,” N Engl J Med, vol. 340, no. 22, pp. 1723–1731, Jun. 1999, doi: 10.1056/NEJM199906033402204.
[10] M. F. Browning, C. Larson, and V. E. Shih, “Fetal Fatty Acid Oxidation Defects and Maternal Liver Disease in Pregnancy.”
[11] Y. Hadi and J. Kupec, “Fatty Liver In Pregnancy,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2022. Accessed: Apr. 03, 2022. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK545315/
[12] M. H, M. M, Y. T, Y. T, A. R, and N. R, “Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts,” The journal of obstetrics and gynaecology research, vol. 40, no. 3, Mar. 2014, doi: 10.1111/jog.12282.
[13] L. C. Casey et al., “Acute Liver Failure (ALF) in Pregnancy: How Much Is Pregnancy Related?,” Hepatology, vol. 72, no. 4, pp. 1366–1377, Oct. 2020, doi: 10.1002/hep.31144.
[14] L. Chang et al., “Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study,” BMC Pregnancy and Childbirth, vol. 20, no. 1, p. 282, May 2020, doi: 10.1186/s12884-020-02980-2.
[15] D. S and R. M, “Retrospective study of seven cases with acute Fatty liver of pregnancy,” ISRN obstetrics and gynecology, vol. 2013, Jun. 2013, doi: 10.1155/2013/730569.
[16] W. X. Tang, Z. Y. Huang, Z. J. Chen, T. L. Cui, L. Zhang, and P. Fu, “Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series,” J Artif Organs, vol. 15, no. 2, pp. 176–184, Jun. 2012, doi: 10.1007/s10047-011-0621-5.
[17] J. Liu, T. T. Ghaziani, and J. L. Wolf, “Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management,” Am J Gastroenterol, vol. 112, no. 6, pp. 838–846, Jun. 2017, doi: 10.1038/ajg.2017.54.
Published
2022-05-30
How to Cite
[1]
B. Alexandru, “ACUTE FATTY LIVER OF PREGNANCY- CASE REPORT AND REVIEW OF LITERATURE”, JSS, vol. 9, no. 1, May 2022.