Acute fatty liver of pregnancy is a rare but usually fatal complication of the last trimester of pregnancy. The main clinical manifestations are malaise, nausea, vomiting, abdominal pain, jaundice, hepatic encephalopathy, increased transaminase
level,
decreased platelet count, increased prothrombin time, and renal failure. The cause remains unknown and the characteristic histologic picture demenstrates microvesicular fatty infiltration of hepatocyte. Liver biopsy is not always necessary for
diagnosis
but may be useful in atypical cases. The primary therapy is early delivery and supportive care.
We report a case of acute fatty liver of pregnancy in a 32-year-old nulliparous woman. She came to this hospital in third trimester or pergnancy with abdominal pain, jaundice, diarrhea. Under the impression of the acute fatty liver of pregnancy,
an
emergency cesarean section was performed. Then she showed the symptoms of altered mental status and acute renal failure, and the laboratory findings of disseminated intravascular coagulation. A computed tomography scan showed acute pancreatitis.
In
collaboration with physicians, maximal supportive care was performed, which included intensive care unit monitoring, blood component therapy, glucose infusion, diuretic agent and adequate antibiotics administration, and fluid-electrolyte balance
maintenance. In spite of the literature's dismal prognosis, our case seemed to be favorable maternal and perinatal outcomes. Therefore prompt recognition and immediate termination of pregnancy with intensive and supportive care are essential to
the
management of fatty liver of pregnancy and the team approach is a crucial component of patient care.
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