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Acute Fatty Liver of Pregnancy: Clinical Features and Diagnosis
Author(s) -
Purdie Jane M.,
Walters B. N. J.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01613.x
Subject(s) - medicine , acute fatty liver of pregnancy , polydipsia , pregnancy , preeclampsia , liver function , vomiting , pediatrics , liver function tests , coagulopathy , obstetrics , diabetes mellitus , surgery , fetus , endocrinology , genetics , biology
EDITORIAL COMMENT: This paper emphasizes the importance of early diagnosis of acute fatty liver of pregnancy and prompt delivery of the patient. When the clinical picture has similarities with severe preeclampsia the patient also needs immediate delivery. The associated feature of polydipsia reported here is an important observation and the writer of this review can recall a severely ill patient in labour in 1960 in whom the consulting physician diagnosed ‘temporary diabetes insipidus in labour’. If these patients do come to Caesarean section (for acute fetal distress or because the condition of the mother is serious or deteriorating rapidly) the problems of blood coagulation failure must be anticipated. Summary: Five cases of acute fatty liver of pregnancy are described. These are the only recognized cases of this disorder occurring in a 2 year period in Western Australia. Clinical and laboratory features are presented. There was no maternal death. Of the six babies, there were three intrauterine deaths, including the only set of twins. All the babies were male. Vomiting in the third trimester was the chief presenting feature in all cases, often accompanied by a systemic illness with malaise and tiredness. Extreme polydipsia was noted as a prominent symptom in all cases. The combination of moderately abnormal liver function tests, extreme leucocytosis with other blood film abnormalities, hypoglycaemia, impaired renal function, coagulopathy and gross elevation of uric acid level is regarded as highly suggestive of the diagnosis. Features of a preeclamptic illness were present in several cases. Three of the patients have since had uneventful pregnancies. The constellation of clinical and laboratory features is sufficiently characteristic to allow accurate clinical diagnosis in most cases of this disorder. The chances of both maternal and fetal survival are enhanced by early diagnosis allowing intervention in the form of prompt delivery of the infant.