Acute fatty liver of pregnancy complicated with ascites and bilateral pleural effusion

ABSTRACT

Acute liver failure may be caused by fulminant viral hepatitis, drug-induced hepatic toxicity, or acute fatty liver of pregnancy. Acute fatty liver of pregnancy is a rare condition that is estimated to affect 1 in 7000 to 16000 pregnancies in the third trimester of pregnancy. The maternal mortality rate has been estimated to be 18%, and neonatal mortality rates have ranged from 7% to 58%. Early diagnosis and treatment, will improve the consequences of the disease in fetuses and mother. A 24-year old woman, gravid 1, was admitted in our hospital with term pregnancy because of labour pain, nausea, vomiting and jaundice. Diagnosis of acute fatty liver of pregnancy was made in this case on the basis of the clinical and para clinical findings. After correction of the coagulation defect with 3 units of FFP, caesarean section was performed because of lack of progression of labour and presence of meconium stain in amniotic fluid. 3 days after the operation, the patient developed ascites and bilateral pleural effusion. Intensive care and supportive measures after caesarean section led to improved hepatic function. We recommend evaluation of liver and kidney function tests and a complete blood count in all patients with nausea, persistent vomiting, or epigastric pain in the third trimester of pregnancy to rule out the diagnosis of acute fatty liver of pregnancy