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. 1994 Jan;35(1):101–106. doi: 10.1136/gut.35.1.101

Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients.

H Reyes 1, L Sandoval 1, A Wainstein 1, J Ribalta 1, S Donoso 1, G Smok 1, H Rosenberg 1, M Meneses 1
PMCID: PMC1374642  PMID: 8307428

Abstract

Twelve episodes of acute fatty liver of pregnancy (AFLP) were diagnosed in 11 patients during the past 18 years in a general hospital in Santiago, Chile, with a prevalence of 1 per 15,900 deliveries. Acute fatty liver of pregnancy started between the 31st and 38th weeks of pregnancy, with malaise, vomiting, jaundice, and lethargy as the main clinical manifestations. Polydipsia (in nine episodes) and skin pruritus (in seven episodes) were unusual clinical findings. In two patients, pruritus started two and four weeks before AFLP, suggesting that an intrahepatic cholestasis of pregnancy preceded AFLP in those patients. Considering the current prevalence of both diseases in Chile, their association should be considered fortuitous. In another patient, two consecutive pregnancies were affected by AFLP, raising to three the number of reported patients with recurrent AFLP. In 11 episodes, liver biopsies supported the diagnosis of AFLP by showing small and midsized vacuolar cytoplasmic transformation as the most prominent histopathological feature. Positive intracellular fat staining was found in the four samples analysed. Studies by electron microscopy showed megamitochondria with paracrystalline inclusions in four samples. All the mothers survived, but fetal mortality was 58.3%. Several extrahepatic complications delayed maternal recovery for up to four weeks after delivery. This study confirms an improvement in maternal prognosis in AFLP, discusses the possibility of an epidemiological association with intrahepatic cholestasis of pregnancy, and increases the number of patients reported with recurrent AFLP.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armas Merino R., Fajurí A., Chapero L., Gostin L., Reid A., Naquira N. Hígado graso agudo obstétrico. Rev Chil Obstet Ginecol. 1973;38(5):214–221. [PubMed] [Google Scholar]
  2. Bacq Y., Constans T., Body G., Choutet P., Lamisse F. La stéatose hépatique aiguë gravidique. J Gynecol Obstet Biol Reprod (Paris) 1986;15(7):851–861. [PubMed] [Google Scholar]
  3. Barton J. R., Sibai B. M., Mabie W. C., Shanklin D. R. Recurrent acute fatty liver of pregnancy. Am J Obstet Gynecol. 1990 Aug;163(2):534–538. doi: 10.1016/0002-9378(90)91191-e. [DOI] [PubMed] [Google Scholar]
  4. Bernuau J., Degott C., Nouel O., Rueff B., Benhamou J. P. Non-fatal acute fatty liver of pregnancy. Gut. 1983 Apr;24(4):340–344. doi: 10.1136/gut.24.4.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bianchi R., Valderrama O., Díaz L., Pisano R. Hígado graso agudo obstétrico. Rev Chil Obstet Ginecol. 1983;48(2):108–115. [PubMed] [Google Scholar]
  6. Bourlière M., Bernuau J., Ducrotte S., Walch R., Rueff B., Benhamou J. P. Polyuro-polydipsie et stéatose hépatique aiguë gravidique. Discussion à propos d'un cas. J Gynecol Obstet Biol Reprod (Paris) 1989;18(1):79–81. [PubMed] [Google Scholar]
  7. Brown M. S., Reddy K. R., Hensley G. T., Jeffers L. J., Schiff E. R. The initial presentation of fatty liver of pregnancy mimicking acute viral hepatitis. Am J Gastroenterol. 1987 Jun;82(6):554–557. [PubMed] [Google Scholar]
  8. Burroughs A. K., Seong N. H., Dojcinov D. M., Scheuer P. J., Sherlock S. V. Idiopathic acute fatty liver of pregnancy in 12 patients. Q J Med. 1982;51(204):481–497. [PubMed] [Google Scholar]
  9. Cammu H., Velkeniers B., Charels K., Vincken W., Amy J. J. Idiopathic acute fatty liver of pregnancy associated with transient diabetes insipidus. Case report. Br J Obstet Gynaecol. 1987 Feb;94(2):173–178. doi: 10.1111/j.1471-0528.1987.tb02346.x. [DOI] [PubMed] [Google Scholar]
  10. Cano R. I., Delman M. R., Pitchumoni C. S., Lev R., Rosenthal W. S. Acute fatty liver of pregnancy. Complication by disseminated intravascular coagulation. JAMA. 1975 Jan 13;231(2):159–161. [PubMed] [Google Scholar]
  11. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-1981. N Engl J Med. 1981 Jan 22;304(4):216–224. doi: 10.1056/NEJM198101223040407. [DOI] [PubMed] [Google Scholar]
  12. DOUVRES P. A., ROSENTHAL W. S., METZGER P., TCHERTKOFF V. ACUTE FATTY LIVER OF PREGNANCY WITH HEPATIC COMA AND MALLORY-WEISS SYNDROME: REPORT OF A CASE. Am J Dig Dis. 1965 Apr;10:306–313. doi: 10.1007/BF02233422. [DOI] [PubMed] [Google Scholar]
  13. Davies M. H., Wilkinson S. P., Hanid M. A., Portmann B., Brudenell J. M., Newton J. R., Williams R. Acute liver disease with encephalopathy and renal failure in late pregnancy and the early puerperium -- a study of fourteen patients. Br J Obstet Gynaecol. 1980 Nov;87(11):1005–1014. doi: 10.1111/j.1471-0528.1980.tb04465.x. [DOI] [PubMed] [Google Scholar]
  14. Durr J. A., Hoggard J. G., Hunt J. M., Schrier R. W. Diabetes insipidus in pregnancy associated with abnormally high circulating vasopressinase activity. N Engl J Med. 1987 Apr 23;316(17):1070–1074. doi: 10.1056/NEJM198704233161707. [DOI] [PubMed] [Google Scholar]
  15. Ebert E. C., Sun E. A., Wright S. H., Decker J. P., Librizzi R. J., Bolognese R. J., Lipshutz W. H. Does early diagnosis and delivery in acute fatty liver of pregnancy lead to improvement in maternal and infant survival? Dig Dis Sci. 1984 May;29(5):453–455. doi: 10.1007/BF01296222. [DOI] [PubMed] [Google Scholar]
  16. Hatfield A. K., Stein J. H., Greenberger N. J., Abernethy R. W., Ferris T. F. Idiopathic acute fatty liver of pregnancy. Death from extrahepatic manifestations. Am J Dig Dis. 1972 Feb;17(2):167–178. doi: 10.1007/BF02232739. [DOI] [PubMed] [Google Scholar]
  17. Holzbach R. T. Acute fatty liver of pregnancy with disseminated intravascular coagulation. Obstet Gynecol. 1974 May;43(5):740–744. [PubMed] [Google Scholar]
  18. Hou S. H., Levin S., Ahola S., Lister J., Omicioli V., Dandrow R., Papageorge W., Kaplan M. Acute fatty liver of pregnancy. Survival with early cesarean section. Dig Dis Sci. 1984 May;29(5):449–452. doi: 10.1007/BF01296221. [DOI] [PubMed] [Google Scholar]
  19. Hsiung R., Hasselmann M., Lutun P., Gordji M. Un cas de stéatose hépatique aiguë gravidique. Intérêt diagnostique de l'hyperuricémie au stade pré-ictérique. J Gynecol Obstet Biol Reprod (Paris) 1988;17(7):901–905. [PubMed] [Google Scholar]
  20. Kaplan M. M. Acute fatty liver of pregnancy. N Engl J Med. 1985 Aug 8;313(6):367–370. doi: 10.1056/NEJM198508083130606. [DOI] [PubMed] [Google Scholar]
  21. Liebman H. A., McGehee W. G., Patch M. J., Feinstein D. I. Severe depression of antithrombin III associated with disseminated intravascular coagulation in women with fatty liver of pregnancy. Ann Intern Med. 1983 Mar;98(3):330–333. doi: 10.7326/0003-4819-98-3-330. [DOI] [PubMed] [Google Scholar]
  22. MOORE H. C. Acute fatty liver of pregnancy. J Obstet Gynaecol Br Emp. 1956 Apr;63(2):189–198. doi: 10.1111/j.1471-0528.1956.tb05458.x. [DOI] [PubMed] [Google Scholar]
  23. Minakami H., Oka N., Sato T., Tamada T., Yasuda Y., Hirota N. Preeclampsia: a microvesicular fat disease of the liver? Am J Obstet Gynecol. 1988 Nov;159(5):1043–1047. doi: 10.1016/0002-9378(88)90407-3. [DOI] [PubMed] [Google Scholar]
  24. Morrin P. A., Handa S. P., Valberg L. S., Bencosme S. A., Kipkie G. F., Wyllie J. C. Acute renal failure in association with fatty liver of pregnancy. Recovery after fourteen days of complete anuria. Am J Med. 1967 May;42(5):844–851. doi: 10.1016/0002-9343(67)90101-5. [DOI] [PubMed] [Google Scholar]
  25. Ockner S. A., Brunt E. M., Cohn S. M., Krul E. S., Hanto D. W., Peters M. G. Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation. Hepatology. 1990 Jan;11(1):59–64. doi: 10.1002/hep.1840110112. [DOI] [PubMed] [Google Scholar]
  26. Paz R. A. Ventajas e inconvenientes del término colecistosis. Acta Gastroenterol Latinoam. 1972 Apr-Jun;4(2):73–74. [PubMed] [Google Scholar]
  27. Pockros P. J., Peters R. L., Reynolds T. B. Idiopathic fatty liver of pregnancy: findings in ten cases. Medicine (Baltimore) 1984 Jan;63(1):1–11. doi: 10.1097/00005792-198401000-00001. [DOI] [PubMed] [Google Scholar]
  28. Pockros P. J., Reynolds T. B. Acute fatty liver of pregnancy. Dig Dis Sci. 1985 Jun;30(6):601–602. doi: 10.1007/BF01320271. [DOI] [PubMed] [Google Scholar]
  29. Quigley M. M. Acute obstetric yellow atrophy presenting as idiopathic hyperuricemia. South Med J. 1974 Feb;67(2):142–144. doi: 10.1097/00007611-197402000-00005. [DOI] [PubMed] [Google Scholar]
  30. Riely C. A. Acute fatty liver of pregnancy--1984. Dig Dis Sci. 1984 May;29(5):456–457. doi: 10.1007/BF01296223. [DOI] [PubMed] [Google Scholar]
  31. Riely C. A. Acute fatty liver of pregnancy. Semin Liver Dis. 1987 Feb;7(1):47–54. doi: 10.1055/s-2008-1040563. [DOI] [PubMed] [Google Scholar]
  32. Riely C. A., Latham P. S., Romero R., Duffy T. P. Acute fatty liver of pregnancy. A reassessment based on observations in nine patients. Ann Intern Med. 1987 May;106(5):703–706. doi: 10.7326/0003-4819-106-5-703. [DOI] [PubMed] [Google Scholar]
  33. Rolfes D. B., Ishak K. G. Acute fatty liver of pregnancy: a clinicopathologic study of 35 cases. Hepatology. 1985 Nov-Dec;5(6):1149–1158. doi: 10.1002/hep.1840050615. [DOI] [PubMed] [Google Scholar]
  34. Schoeman M. N., Batey R. G., Wilcken B. Recurrent acute fatty liver of pregnancy associated with a fatty-acid oxidation defect in the offspring. Gastroenterology. 1991 Feb;100(2):544–548. doi: 10.1016/0016-5085(91)90228-d. [DOI] [PubMed] [Google Scholar]
  35. Slater D. N., Hague W. M. Renal morphological changes in idiopathic acute fatty liver of pregnancy. Histopathology. 1984 Jul;8(4):567–581. doi: 10.1111/j.1365-2559.1984.tb02369.x. [DOI] [PubMed] [Google Scholar]
  36. Vanjak D., Moreau R., Roche-Sicot J., Soulier A., Sicot C. Intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy. An unusual but favorable association? Gastroenterology. 1991 Apr;100(4):1123–1125. doi: 10.1016/0016-5085(91)90292-s. [DOI] [PubMed] [Google Scholar]
  37. WOOLF A. J., JOHNSTON A. W., STOKES J. F., ROBERTON N. R. ACUTE LIVER FAILURE IN PREGNANCY; CASE REPORT WITH SURVIVAL OF MOTHER AND CHILD. J Obstet Gynaecol Br Commonw. 1964 Dec;71:914–918. doi: 10.1111/j.1471-0528.1964.tb04379.x. [DOI] [PubMed] [Google Scholar]
  38. Zambra G., Cabrera R., Ugarte G., Rubio J., Gonzalez J. Hígado graso agudo del embarazo. Rev Chil Obstet Ginecol. 1968;33(6):395–402. [PubMed] [Google Scholar]

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