Acute fatty liver disease of pregnancy-report of two cases from tertiary care centre, Hyderabad
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20231016Keywords:
AFLP, Acute hepatic failure, Liver disorders in pregnancy, Jaundice in pregnancy, HELLP syndromeAbstract
A referral case from Kollampally, Narayanpet, primi past EDD by 2 days, thrombocytopenia and elevated bilirubin levels. EDC-18.09.22, scan EDC- 26.09.22 She had a vaginal septum and a poor Bishop score. During caesarean section, there was atonic post-partum haemorrhage, (PPH). When PPH could not be controlled with medical management, Haymans stitches were applied to control the bleeding. Total she received seventeen units of blood products, (4 FFPS, 1 SDP, 2 PRBC, 10 CRYO). She succumbed on the fourth POD. Fulminant hepatic failure, hepatic encephalopathy, grade 111, oliguric, AKI, thrombocytopenia, coagulopathy, with sepsis. The second case, a 24 years primi, 38 weeks 4 days, jaundice of three days duration, with HELLP? AFLP, thrombocytopenia with poor Bishop score. This case was a referral from SVS medical college, Mahaboob Nagar (MBNR) on 25.10.22, 7.23pm. An emergency LSCS was performed on 26.10. 22, 2.15 am. Blood products 25 units, (1 PRBC, 8 FFP, 6 RDP, 10 Cryo) units transfused. Intra operative blood loss was 1250 ml. Atonic PPH was managed adopting both medical and surgical, methods. An alive male 3200 gm was delivered. Measures taken to control PPH were, misoprostol 800 mcg PR, inj.oxytocin 20 units i.v drip, uterine massage, Inj. Carboprost was given. Modified B Lynch uterine compression sutures were applied. Bilateral uterine artery ligation was done. Abdominal drain kept. AKI, sepsis and increasing bilirubin levels were noted. At OGH two sessions of haemodialysis were done. Patient expired on 28.10.22. Persistent hypoglycemia, elevated bilirubin, low fibrinogen, prolonged PT and INR pointed to a diagnosis of AFLP.
References
Liu J, Ghaziani TT, Wolf JL. Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. Am J Gastroenterol. 2017;112(6):838-46.
Afridi FR, Michael F, Raju R. Acute Fatty Liver Disease of Pregnancy in the Second Trimester. Case Report. Hindawi Case Reports in Critical Care. 2020;6705784:5.
Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P. A prospective national study of acute fatty liver of pregnancy in the UK. Gut. 2008;57:951-6.
Ch’ng CL, Morgan M, Hainsworth I, Kingham JGC. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut. 2002;51(6):876-80.
Nelson DB, Byrne JJ, Cunningham FG. Acute fatty liver of pregnancy. Clin Obstet Gynecol. 2020;63:152-64.
Nelson DB, Byrne JJ, Cunningham FG. Acute fatty liver of pregnancy. Obstet Gynecol. 2021;137:535-46.
Byrne JJ, Seasely A, Nelson DB. Comparing acute fatty liver of pregnancy from hemolysis, elevated liver enzymes, and low platelets syndrome. J Matern Fetal Neonatal Med. 2020:1-11.
Hammoud GMJA. Preeclampsia-induced liver dysfunction, HELLP syndrome, and acute fatty liver of pregnancy. Clinical Liver Dis. 2014;4:69-73.
Bacq Y: Liver diseases unique to pregnancy: A 2010 update. Clin Res Hepatol Gastroenterol. 2011;35:182-93.
Mjahed K, Charra B, Hamoudi D, Noun M, Barrou L: Acute fatty liver of pregnancy. Arch Gynecol Obstet. 2006;274:349-53.
Moldenhauer JS, O’Brien JM, Barton JR, Sibai B. Acute fatty liver of pregnancy associated with pancreatitis: a life-threatening complication. Am J Obstet Gynecol. 2004;190(2):502-5.
Nelson DB, Byrne JJ, Cunningham FG. Acute fatty liver of pregnancy. Obstet Gynecol. 2021;137(3):535-46.
Ringers J, Bloemenkamp K, Francisco N, Blok JJ, Arbous MS, Van Hoek B. Auxiliary or orthotopic liver transplantation for acute fatty liver of pregnancy: Case series and review of the literature. BJOG 2016;123:1394-8.
Xiong HF, Liu JY, Guo LM, Li XW. Acute fatty liver of pregnancy: Over six months follow-up study of twenty-five patients. World J Gastroenterol. 2015;21:1927-3161.
Marques P, Gunawardana K, Grossman A: Transient diabetes insipidus in pregnancy. Endocrinol Diabetes Metab Case Rep. 2015;2015:150078.
Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding outcomes: A systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev. 2015;29:231-41.
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage: An international, randomized, double-blind, placebo-controlled trial. Lancet 2017;389:2105-16.
Rajasri AG, Srestha R, Mitchell J. Acute fatty liver of pregnancy (AFLP): An overview. J Obstet Gynaecol 2007;27:237-40.
Meng Z, Fang W, Meng M, Zhang J, Wang Q, Qie G et al. Risk Factors for Maternal and Fetal Mortality in Acute Fatty Liver of Pregnancy and New Predictive Models. Front Med. 2021;8:719906.
Chen G, Huang K, Ji B, Chen C, Liu C, Wang X et al. Acute fatty liver of pregnancy in a Chinese tertiary care center: a retrospective study. Arch Gynecol Obstet. 2019;300:897-901.
Sitaula S, Agrawal A, Thakur A, Manandhar T, Thapa BD, Dhamala J. Acute Fatty Liver of Pregnancy: A Life Threatening Condition. Nep J Obstet Gynecol. 2020;15(30):79–80. DOI: 10.3126/njog.v15i1.29348.
Wang L, Gan Q, Du S, Zhao Y, Sun G, Lin Y et al. Acute fatty liver of pregnancy cases in a maternal and child health hospital of China: three case reports. Medicine. 2020;99:29(e21110).
