Case of Complicated Fatty Liver of Pregnancy With Good Outcome

Abstract

Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.