Attached
j.cute fatty liver in pregnancy shows a spectrum of presentations ranging from sub clinical hepatic
dysfunction evidenced by elevated liver enzymes to hepatic failure, coma and death. Affected
women present in the latter half of the pregnancy. It is more common in patients with multiple
gestations and possibly in women who are under weight. The clinical outlook is related to the
incipient hepatic failure, such as nausea and vomiting, bleeding, jaundice and coma.
CASE REPORT
The deceased was a 20 year old primigravida with a POA of 33 weeks, developed loss of appetite,
nausea and yellowish discolburatipn of eyes. Her first and second trimesters were uneventful and
she was transferred from a peripheral hospital with features of liver failure. An emergency LSCS
was done to deliver three live fetuses. As bleeding was not settled, abdominal hysterectomy had
to be done at the same time. Managed at the intensive care unit where she was pronounced dead
four days after hysterectomy.
During autopsy liver was normal in size, with focal areas of necrosis and fatty change and patent
common bile duct. Luhgs were heavy with features of adults respiratory distress syndrome. Brain
is oedematous with congested vessels. Rest of the organs showed congestion. Histological
examination confirmed massive liver cell necrosis with microvescicular steatosis in surviving
t cells and lymphocytic infiltration in portal tracts. The cause of death was concluded as multi
m failure in a patient with acute j^tty liver in pregnancy.
CONCLUSION
The diagnosis of AFLP depends on a high index of suspicion and microvesicular steatosis. Most
commonly this condition runs a mild course, but it can progress within days to hepatic failure and
death as seen in this case.
