Korean J Obstet Gynecol.
2006 Mar;49(3):674-681.
Acute fatty liver of pregnancy complicating acute respiratory distress syndrome: A case report with survival of mother and child
- Affiliations
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- 1Department of Obstetrics and Gynecology, Yong-Dong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. dr3431@yumc.yonsei.ac.kr
Abstract
- We report our experience with the diagnostic, clinical and biochemical findings, complications and maternal-perinatal outcome in a case of acute fatty liver of pregnancy. A 31-year-old multipara presented herself at 35 weeks' gestation with general malaise, gastroesophageal reflux, jaundice, hepatorenal dysfunction and disseminated intravascular coagulation. An abdominal ultrasound revealed a mild fatty liver. A tentative diagnosis of acute fatty liver of pregnancy was made, and immediately a healthy male infant weighing 2330 gm was delivered by emergency cesarean section. On 1, 2 and 6 days after delivery, oliguria, acute respiratory distress syndrome and pancreatitis developed, respectively. Abnormal levels of AST/ALT, creatinine, fibrinogen, PT/PTT and platelet recovered to normal ranges 7-10 days after delivery. Serum amylase and lipase became normal 24 days after delivery with conservative treatment. Ventilator care for acute respiratory distress syndrome continued up to 49 days after delivery, when total bilirubin, ammonia, alkaline phosphatase, r-GT, and AST/ALT began to normalize. The discharge was recommended on the 88th postpartum day. Our result suggests that acute fatty liver of pregnancy can be diagnosed on the basis of clinical and laboratory findings. Prompt delivery, intensive supportive care and awareness of its complications can markedly improve maternal and perinatal outcome.
Keyword
MeSH Terms
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Adult
Alkaline Phosphatase
Ammonia
Amylases
Bilirubin
Blood Platelets
Cesarean Section
Child*
Creatinine
Diagnosis
Disseminated Intravascular Coagulation
Emergencies
Fatty Liver*
Female
Fibrinogen
Gastroesophageal Reflux
Humans
Infant
Jaundice
Lipase
Male
Mothers*
Oliguria
Pancreatitis
Postpartum Period
Pregnancy*
Reference Values
Respiratory Distress Syndrome, Adult*
Ultrasonography
Ventilators, Mechanical
Alkaline Phosphatase
Ammonia
Amylases
Bilirubin
Creatinine
Fibrinogen
Lipase
