Acute Fatty Liver of Pregnancy: Case series report

Acute fatty liver of pregnancy, a rare clinical entity demands early diagnosis, immediate delivery of fetus, systematic approach for correction of coagulopathy, renal injury & sepsis along with hemodynamic and ventilatory support till complete recovery. We report a series of 3 AFLP cases, who underwent emergency LSCS. Case description: The first case was admitted with abdominal pain, vomiting, icterus and pedal edema. Clinical examination was unremarkable with normal blood pressures and no bleeding manifestations externally. After further investigations, LSCS was performed under GA with controlled ventilation and multiple blood products. Postoperatively patient developed acute kidney injury, for which Hemodialysis was instituted and continued for 10 days. Patient discharged following recovery of renal and liver functions after 45 days. The second case presented with similar clinical profile, had persistent severe lactic acidosis, required higher inotropic support, progressive worsening of liver and renal function tests not amenable to corrective measures leading to mortality. The third patient presented without coagulopathy in spite of elevated bilirubin and liver enzymes. Prophylactic vitamin K therapy was given and LSCS was performed under spinal anesthesia. Patient had uneventful postoperative course with normal LFT. Conclusion: Patients with AFLP have significant perioperative mortality and morbidity secondary to renal dysfunction, coagulopathy and massive transfusion related complications. Clinical outcome can be improved by early diagnosis, urgent delivery of fetus and supportive care from multidisciplinary team.