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2Discussion

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Volume 108, Issue 2
February 2001
Pages 222–223

Acute fatty liver of pregnancy at 23 weeks of gestation

Authors
Shunji Suzuki,

1. Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan

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Shoichi Watanabe,

1. Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan

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Tsutomu Araki

1. Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan

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First published: February 2001Full publication history

DOI: 10.1111/j.1471-0528.2001.00028.x View/save citation
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*Dr S. Suzuki, Department of Obstetrics and Gynaecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku
Tokyo 113-8603, Japan

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1Case report
A 27 year old woman was referred to her private medical clinic at 23 weeks and 6 days of gestation because of a
one week history of abdominal pain, fatigue, nausea and vomiting. Laboratory tests revealed a white blood count
of 13,200/mm3 (normal range: 4000–8000/mm3), haemoglobin of 12.1 g/dL (normal range: 12-16 g/dL) and

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3/8/2018 Acute fatty liver of pregnancy at 23 weeks of gestation - Suzuki - 2001 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Onli…

platelets of 362,000/mm3 (normal range: 200,000-400,000/mm3). Liver tests resulted in a total bilirubin count of
2.3 mg/dL (normal range: 0.2-1.2 mg/dL), glutamic-oxaloacetic transaminase of 818 iu/L (normal range: 10-28
iu/L) and glutamic-pyruvic transaninase of 705 iu/L (normal range 5-33 iu/L). The fetus was alive at admission,
but intrauterine fetal demise was diagnosed using ultrasound at a gestation age of 24 weeks and 1 day. She was
referred to our hospital on the following day.

She was a well developed woman with jaundice. Her blood pressure was 114/50 mmHg. There was no
hepatosplenomegaly. Tests for hepatitis B (HB) surface antigen, IgM anti-HAV, and anti-HCV were all negative.
At admission to our hospital, laboratory tests revealed a white blood count of 19,400/mm, haemoglobin of 13.0
g/dL, platelets of 242,000/mm, glucose of 57 mg/dL (normal range: 70-110 mg/dL), creatinine of 1.46 mg/dL
(normal range: 0.6-1.2 mg/dL), total bilirubin count of 3.3 mg/dL, GOT of 818 iu/L, GPT of 658 iu/L, and uric
acid of 11.0 mg/dL (normal range: 2.3-6.0 mg/dL). The prothrombin time was prolonged (16.1 seconds; normal
range: <12.5 seconds). Antithrombin was 18% (normal range: 80-120%) and the fibrin degeneration products
level was 47.0 μg/mL (normal range: <10μg/mL). An abdominal ultrasound examination revealed a slightly fatty
liver with a normal biliary tree.

On this information, the she was diagnosed as having acute fatty liver of pregnancy complicated by intrauterine
fetal demise. On the next day, a male dead fetus weighing 650 g was delivered vaginally. The estimated blood
loss was 870 mL. Her haemoglobin and platelets decreased to 8.7 g/dL and 110,000/mm3, respectively. The
coagulation disorders were corrected with intravenous infusion of antithrombin and fresh frozen plasma.

Two days after delivery, her glutamic-oxaloacetic transaminase, glutamic-pyruvic transaninase and fibrin
degeneration products levels decreased to 48 iu/L, 52 iu/L and 8.8 μg/mL, respectively. Seven days after
delivery, her platelets increased to 214,000/mm3. Her condition improved promptly, and she was discharged
from the hospital two weeks later.

2Discussion
Acute fatty liver of pregnancy is a rare but life threatening complication. The mean gestational age onset of
symptoms of acute fatty liver of pregnancy has been reported to be 35-37 weeks of gestation1,2. Recently,
Jwayyed et al.3 and Buytaert et al.4 described two patients at 26 weeks as the earliest cases of acute fatty liver of
pregnancy. In this report, however, we present a case of acute fatty liver of pregnancy at 23 weeks of gestation.

In this case, the interval between symptom occurrence and fetal demise was only one week, and the woman
recovered quickly after delivery. Although we did not perform liver biopsy, this case may be diagnosed as acute
fatty liver of pregnancy on the basis of clinical and labouratory criteria as reported by Castro et al.2

Acute fatty liver of pregnancy can lead to hepatic failure and death of both mother and child if the diagnosis is
not made in a timely manner5. Although some investigators have suggested that the decrease in mitochondrial
oxidation of fatty acids associated with sex hormones contribute to the development of acute fatty liver of
pregnancy, the exact cause of acute fatty liver of pregnancy has not been established6–8. Thus, there is no
specific treatment for acute fatty liver of pregnancy except prompt termination of pregnancy. With adequate
delivery and support, all women with acute fatty liver of pregnancy have been reported to have full recovery of
hepatic function5. However, this management may be inadequate in the early occurrence of acute fatty liver of
pregnancy, such as in our case, if the fetus is alive in utero, because the fetus is still immature. In addition, some
cases of recurrent acute fatty liver of pregnancy during subsequent pregnancy have been reported8,9. Further
examination concerning the exact mechanisms of acute fatty liver of pregnancy is needed.

Ancillary
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DOI

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Publication History

Issue online: 22 December 2003

Version of record online: 22 December 2003
Accepted 2 November 2000

References

1 Knox T.A., Olans L.B.. Liver disease in pregnancy. N Engl J Med 1985;313: 367–370.
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2 Gastro M.A., Fassett M.J., Reynolds T.B., Shaw K.J., Goodwin T.M.. Reversible peripartum liver failure:
a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28
consecutive cases. Am J Obstet Gynecol 1991;181: 389–395.
3 Jwayyed S.M., Blanda M., Kubina M.. Acute fatty liver of pregnancy. J Emerg Med 1999;17: 673–677.
CrossRef |
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4 Buytaert I.M., Elewaut A.G., Van Kets H.E.. Early occurrence of acute fatty liver in pregnancy. Am J
Gastroenterol 1996;91: 603–604.
PubMed |
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5 Bacq Y.. Acute fatty liver of pregnancy. Semin Perinatol 1998;22: 134–140.
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6 Grimbert S., Fromentry B., Fisch C., et al. Decreased mitochondrial oxidation of fatty acids in pregnant
mice: possible relevence to development of acute fatty liver of pregnancy. Hepatology 1993;17: 628–637.
Wiley Online Library |
PubMed |
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7 Grimbert S., Fisch C., Deschamps D., et al. Effects of female sex hormones on mitochondria: possible
role in acute fatty liver of pregnancy. Am J Physiol 1995;268: G107–G115.
PubMed |
Web of Science® Times Cited: 27
8 Schoeman M.N., Batey R.G., Wilcken B.. Recurrent acute fatty liver of pregnancy associated with a fatty
acid oxidation defect in the off-spring. Gastroenterology 1991;100: 544–548.
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Web of Science® Times Cited: 54

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3/8/2018 Acute fatty liver of pregnancy at 23 weeks of gestation - Suzuki - 2001 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Onli…

9 Przepiesc J., Redzko S., Urban J.. Acute fatty liver of pregnancy: treatment, prognosis, rules of
management. Ginekol Pol 1999;70: 205–209.
PubMed

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