Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 55 , ISSUE 3 ( July-September, 2021 ) > List of Articles

CASE REPORT

A Case Series of Fatal Fulminant Hepatic Failure in Postpartum Females Secondary to Acute Fatty Liver of Pregnancy

Anant Parasher, Vandana Mohan

Keywords : Acute fatty liver of pregnancy, Hypoglycemia, Liver transplant, Molecular absorbent recirculating system

Citation Information :

DOI: 10.5005/jp-journals-10028-1434

License: CC BY-NC 4.0

Published Online: 00-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Acute fatty liver of pregnancy (AFLP) is a dreaded complication seen mostly in the third trimester of pregnancy. It carries significant perinatal and maternal mortality and requires early diagnosis and intervention to prevent maternal and fetal death. If untreated, AFLP can lead to complications, such as, disseminated intravascular coagulation (DIC), renal failure, clotting disorders and coagulopathy, hypoglycemia, fulminant hepatic failure, and eventually multiorgan dysfunction. Even though induction of labor with delivery remains the only real cure for this disease, some other therapies for complicated cases include plasmapheresis with renal replacement, and the use of molecular absorbent recirculating system (MARS). Orthotopic liver transplantation has proved to be effective in cases that progress to multiorgan failure despite aggressive therapy. Here, we present two cases who presented to the hospital with near term pregnancies and features of AFLP. Both the patients rapidly worsened postpartum due to persistent bouts of hypoglycemia and rapidly developing fulminant hepatic failure. Despite all our efforts, both the patients expired a few days after admission.


PDF Share
  1. Borwning MF, Levy HL, Wilkins‐Haug L, et al. Fetal fatty acid oxidation defects and maternal liver disease in pregnancy. Obstet Gynecol 2006;107(1):115–120. DOI: 10.1097/01.AOG.0000191297.47183.bd.
  2. Sheehan HL. The pathology of acute yellow atrophy and delayed chloroform poisoning. J Obstet Gynaecol Br Emp 1940;47(1):49–62. DOI: 10.1111/j.1471-0528.1940.tb14731.x.
  3. Tran TT, Ahn J, Reau NS. ACG clinical guideline: liver disease and pregnancy. Am J Gastroenterol 2016;111(2):176–194. DOI: 10.1038/ajg.2015.430.
  4. Ockner SA, Brunt EM, Cohn SM, et al. Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation. Hepatol 1990;11(1):59–64. DOI: 10.1002/hep.1840110112.
  5. Perera I, Pradeepan J, Mayorathan U, et al. A case of fatal acute fatty liver of pregnancy and literature review. Int J Reprod Contracept Obstet Gynecol 2018;7(5):2026–2030. DOI: 10.18203/2320-1770.ijrcog20181950.
  6. Wand S, Waeschle RM, Von Ahsen N, et al. Acute liver failure due to acute fatty liver of pregnancy. Minerva Anestesiol 2012;78:503–506.
  7. Ronen J, Shaheen S, Steinberg D, et al. Acute fatty liver of pregnancy: a thorough examination of a harmful obstetrical syndrome and its counterparts. Cureus 2018;10(2):e2164. DOI: 10.7759/cureus.2164.
  8. Pandey C, Pandey V, Tandon M, et al. Acute liver failure in pregnancy: challenges and management. Indian J Anaesth 2015;59(3):144. DOI: 10.4103/0019-5049.153035.
  9. Bacq Y. The liver diseases in pregnancy. In: Schiff ER, Sorrell MF, Schiff L, et al., ed. Schiff's Diseases of the Liver. 10th ed., Lippincott: Williams and Wilkins; 2006. pp. 1281–1304.
  10. Hay J. Liver disease in pregnancy. Hepatol 2008;47(3):1067–1076. DOI: 10.1002/hep.22130.
  11. De Naeyer S, Ysebaert D, van Utterbeeck M, et al. Acute fatty liver of pregnancy and molecular absorbent recirculating system (MARS)-therapy: a case report. J Matern Fetal Neonatal Med 2008;21(8):587–589. DOI: 10.1080/14767050802053198.
  12. Seyyed Majidi MR, Vafaeimanesh J. Plasmapheresis in acute fatty liver of pregnancy: an effective treatment. Case Rep Obstet Gynecol 2013;2013:615975. DOI: 10.1155/2013/615975.
  13. Yu CB, Chen JJ, Du WB, et al. Effects of plasma exchange combined with continuous renal replacement therapy on acute fatty liver of pregnancy. Hepatobiliary Pancreat Dis Int 2014;13(2):179–183. DOI: 10.1016/S1499-3872(14)60028-X.
  14. Bellig LL. Maternal acute fatty liver of pregnancy and the associated risk for long-chain 3-hydroxyacyl-coenzyme a dehydrogenase (LCHAD) deficiency in infants. Adv Neonat Care 2004;4(1):26–32. DOI: 10.1016/j.adnc.2003.12.001.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.