Abstract
Background: Acute fatty liver of pregnancy is rare and potentially lethal, occurring mainly in the third trimester of pregnancy, and can also occur in the immediate postpartum period, with a prevalence of 1 in every 16,000 pregnancies. It mainly occurs in primigravida women and is associated with preeclampsia, male newborn, multiple pregnancies, BMI < 20, and maternal obesity. The signs and symptoms are nonspecific and can progress to severe cases, even leading to maternal and fetal death. Diagnosis is based on Swansea criteria. The only effective treatment is delivery, and supportive treatment is essential.
Aim: To report a case of acute fatty liver of pregnancy treated in our service.
Case report: Patient a 28-year-old primigravida with untreated gestational diabetes mellitus, at term gestational age, presenting with lower abdominal pain, decreased fetal movement, and fetal bradycardia. A cesarean section was performed, and premature placental abruption was observed. The patient developed hypoglycemia, poor general condition, coagulopathy, and jaundice. The patient developed hepatic encephalopathy, which was reversed. After 19 days of hospitalization, she showed clinical improvement, was discharged, and followed up with a multidisciplinary team.
Conclusion: Acute fatty liver of pregnancy (AFLP) is pregnancy-exclusive pathology, associated with a potentially fatal clinical course that can lead to multiple organ failure. Regardless of the timing of occurrence, AFLP presents with a similar and indistinguishable presentation. The only consideration that must be taken into account is the appropriate treatment for each period, always considering that delivery is the only treatment that establishes a cure.
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