Fate of a Primigravida Women with Acute Fatty Liver of Pregnancy (AFLP) Complicated with Multiorgan Dysfunction Syndrome (MODS): An Obstetric Emergency

Abstract

Conditions of causing liver dysfunction, unique to pregnancy may often be difficult to establish the diagnosis. Failing to do so can result in unwanted complexities leading to higher morbidity or mortality both for mother and fetus. Hence, we have a case report of a 23-year-old disoriented, semi-conscious, deeply icteric, primigravid, 35 weeks 5 days twin pregnancy patient. She had complaints of severe abdominal pain, nausea and vomiting along with features of multiorgan dysfunction syndrome (MODS) due to Acute Fatty Liver of Pregnancy. Considering the patients history and clinical evidences, the differential diagnoses was “HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets)” and “Acute Fatty Liver of Pregnancy (AFLP)”. Though the commonly reported HELLP syndrome and uncommon AFLP often mimic each other, clinically, these differ largely in patho-physiological characteristics, quite distinctly. While diagnosis of HELLP syndrome usually based both on clinical and some essential investigations findings, diagnosis of AFLP is based on the clinical presentation itself in adjunct with clear cut compatible laboratory findings using Swansea criteria. Coincidentally, definitive management of both cases is termination of pregnancy. Hence immediate termination of pregnancy along with supportive treatment of liver failure is the main stay management for the optimal maternal and fetal outcome in AFLP, as globally reported.

The Journal of Ad-din Women's Medical College; Vol. 12 (1), Jan 2024; p 47-52