Acute Fatty Liver of Pregnancy

A report describes a case of an 18-year-old primiparous with an estimated gestational age (EGA) of 35 weeks and 6 days who presented in preterm labour. She reported being generally unwell for 4 days before presentation and experienced nausea, vomiting and yellowing of the eyes for the same duration with no pruritus. She gave no history of diarrhoea or flu-like symptoms. Her Antenatal Clinic (ANC) visits were unremarkable. She gave no travel history to a malaria endemic area. Her Human Immunodeficiency Virus (HIV) status was negative. She reported no chronic illnesses or history of paracetamol, asprin, sodium valproate or herbal medicine ingestion. 

Clinical examination displayed a deeply jaundiced, fully conscious patient at the initial examination. Her vitals, Respiratory and cardiovascular examinations were normal. Her abdomen was soft, without hepatomegaly or splenomegaly. The height of the fundus was 35 weeks and the foetal heart was present and normal. 

She presented with thin meconium-stained liquor drainage and progressed to a spontaneous vaginal delivery of a baby boy with an Apgar score of 9/10 and a birth weight of 2,230 g. 

She did not experience postpartum haemorrhage and was admitted to the early labour ward for observation. Her vital signs remained normal. A comparison of haematogical and renal tests performed upon admission and then 48 h later showed an increasing white blood cell count (WBC) (26 to 50 cells/mm3), urea (14.3 to 17.9), potassium (4.87 to 5.6 mmol/l); and a decreasing haemoglobin (11.1 to 4.7 g/dl) hyponatremia (sodium 134.5 to 127 mmol/l). Platelets (PLT) remained normal (189-221 × 103). 

The liver function tests revealed elevated alkaline phosphatase (ALP) (331 to 277 IU/L) and gamma-glutamyl transpeptidase (GGT) (228 to 206 IU/L) with mildly elevated aspartate aminotransferase (AST) (39 to 52 U/l) and alanine aminotransferase (ALT) (48 TO 39 U/l). Total protein and albumin were normal, while Total bilirubin was not available. 

Her reports were negative for Hepatitis A and B; Rapid Diagnostic Test (RDT) for malaria; and urinalysis. She experienced several episodes of hypoglycaemia (1.1–2.3 mmol/l) which were managed with 50% dextrose followed by an infusion of 10% dextrose 8 hourly. Coagulation studies and uric acid were requested on day 3 but were not available at the hospital. She received 3 units of packed cells. 

Her clinical condition deteriorated on the third-day post-delivery as she became confused and started vomiting coffee ground material. The patient deceased on the 3rd day post-delivery. Her neonate was referred to pediatricians for ongoing care. Post mortem and histology results confirmed the diagnosis of acute fatty liver of pregnancy.

Ziki E, Bopoto S, Madziyire MG, Madziwa D. Acute fatty liver of pregnancy: a case report. BMC Pregnancy Childbirth. 2019 Jul 22;19(1):259. doi: 10.1186/s12884-019-2405-5. PMID: 31331287; PMCID: PMC6647299