A case of acute fatty liver of pregnancy treated with life-saving intensive care

Abstract

Acute fatty liver of pregnancy (AFLP) is a serious maternal illness caused by microvesicular fatty infiltration of hepatic and renal cells that can arise during the third trimester of pregnancy and result in significant perinatal and maternal mortality. We describe AFLP with hepatic and renal failure, multiple organ failure and disseminated intravascular coagulation (DIC) in a 43-year-old woman at 36 weeks of pregnancy. She was treated with respiratory and circulatory management in the ICU after Cesarean delivery. On postoperative day 1, she had perihepatic hematoma after liver biopsy for a diagnosis of AFLP and severe hemorrhage. She was transfused with a large volume of blood products and administered with blood coagulation factor (recombinant activated factor VII). She also underwent continuous hemodiafiltration and three transcatheter arterial embolizations. Her general status improved and she was discharged from the ICU on postoperative day 9. This experience indicated that in a patient with AFLP and hepatic failure, liver biopsy entails a risk of severe hemorrhage, and that liver biopsies for a diagnosis AFLP should be performed after recovering from coagulopathy.