CLINICAL FEATURES AND POSTNATAL CARE OF ACUTE FATTY LIVER OF PREGNANCY: REPORT OF THREE CASES
Abstract Number: 118
Abstract Type: Case Report/Case Series
Hepatic disease complicates 3% all pregnancies. This is a case series of patients with Acute Fatty Liver of Pregnancy.
CASE 1: 20 year old primigravid, at 38 weeks, complaining of malaise, nausea, vomit and epigastric pain. Her physical exam was hypertension, tachycardia and jaundice. A cesarean section (C-section) under spinal anesthesia by a non reassuring fetal status (NRFS) was done. The diagnosis was HELLP syndrome; she required mechanical ventilation 8 days by a neurological impairment; coagulopathy and acute renal failure with hemodyalisis. A tracheal resection for stenosis was made. Her evolution was satisfactory. Liver biopsy showed macro vesicular infiltration.
CASE 2: 36 year old woman, primigravid, at 36 weeks, complaining of abdominal pain, malaise, coluria and jaundice. Her physical exam was normal. The diagnosis was HELLP syndrome; coagulopathy and renal failure were present. C-section under general anesthesia, by a non reassuring fetal status (NRFS) was done. Her evolution was satisfactory
CASE 3: 28 year old woman, primigravid, at 36 week, complaining of jaundice, abdominal pain and coluria. Her physical exam was jaundice, tachycardia; suddenly she developed hypotension, fetal bradycardia and mild vaginal bleeding, with a diagnosis of placental abruption a C-section under general anesthesia was done, hypoglycemia was identified and corrected during surgery. At high dependency unit she was unstable with high vasopressors requirements, mechanical ventilation and acceptable neurological evaluation; by a surgical wound bleeding she received FFP, and PRBC, hemodyalisis was necessary by acute renal failure. She was referred to a hepatology service for a liver transplant evaluation by persistent coagulopathy and hepatic dysfunction. After 24 hours ICP catheter was placed because she had neurological impairment, with a fatal parenquimatous bleeding.
DISCUSSION: Hepatic diseases in pregnancy are rare but potentially fatal, with a wide findings range. Initial unspecific symptoms can evolve to a fulminating liver failure; typically patients show a total recovery after delivery. The main differential diagnosis is HELLP syndrome. Diagnosis tools, like in our patient, are