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Korean Journal of Obstetrics & Gynecology 2006;49(12):2604-2611.
Published online December 1, 2006.
Acute Fatty Liver of Pregnancy: two cases of favorable outcome.
In Sook Sohn, Ji Yeon Kim, Han Sung Kwon, Sun Ju Lee, Ji Young Lee, Soo Nyung Kim, Won Hyeok Choe, Nam Sik Woo, Hye Seung Han
1Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea. sohnis@kuh.ac.kr
2Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
3Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea.
4Department of Pathology, Konkuk University School of Medicine, Seoul, Korea.
Abstract
Acute fatty liver of pregnancy is a rare but usually fatal complication of the last trimester of pregnancy. The primary therapy is early delivery and supportive care. We report two cases of favorable outcomes in acute fatty liver of pregnancy. First case was a nulliparous twin pregnant woman at 33 weeks of gestation with jaundice, abdominal pain, and diarrhea. Because the acute fatty liver of pregnancy was diagnosed by typical laboratory findings, an emergency cesarean section was performed. Then, she showed the symptoms of acute renal failure, and the laboratory findings of disseminated intravascular coagulation. Second case was a nulliparous women at 37 weeks of gestation with malaise, upper abdominal pain, and elevated transaminase level. Under the impression of the acute fatty liver of pregnancy and fetal distress, an emergency cesarean section was performed under both epidural and general anesthesia. Liver biopsy was performed and showed microvesicular fatty infiltration of hepatocyte. In spite of the literature's dismal prognosis, our cases seemed to be favorable maternal and perinatal outcomes because of early recognition and immediate termination of pregnancy with intensive and supportive care.
Key Words: Acute fatty liver of pregnancy, Liver biopsy, Anesthesia


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