EC Gynaecology

Background: Acute fatty liver of pregnancy (AFLP) is considered a rare and life-threatening obstetric emergency that generally affects pregnancies in the third trimester, as well as in the postpartum period. Its incidence is reported to affect 1 in every 100,000 pregnancies. This pathology is characterized by acute liver failure, which is preceded by fatty infiltration of the liver. Associated with high rates of maternal and perinatal morbidity and mortality of up to 80% when it occurs.

Clinical Case: 21-year-old patient, who enters a first-level health care unit with a third trimester pregnancy and labor, as well as an attack on her general condition, nausea, vomiting, mild jaundice generalized abdominal pain, as well as laboratory studies with anemia, thrombocytopenia, leukocytosis and hypoglycemia. After vaginal birth it began with transvaginal hemorrhage, final quantification of blood loss at 1,550 ml. Referred for advanced life support to a higher health center, upon arrival with multidisciplinary management in the Intensive Care Unit (ICU) with progressive hemodynamic deterioration, the time of death being declared later, in whom a diagnostic necropsy was performed, with histopathological report of AFLP.

Conclusion: It is considered an extremely rare, but potentially fatal complication, with serious consequences for both the mother and the fetus. Faced with a pregnant patient who triggers a clinical picture highly suspicious of AFLP, based mainly on compliance with > 6 of the Swansea criteria, always taking into account that not in all cases it presents as a single entity, and can be correlated with other pathologies that complicate the second and third trimesters of pregnancy.

 Keywords: Acute Fatty Liver of Pregnancy; Liver Dysfunction; Disseminated Intravascular Coagulation; Obstetric Hemorrhage; Maternal Morbidity and Mortality

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