Acute fatty liver disease in full-term pregnancy: a case report and review of the literature.

BACKGROUND: Cases of acute fatty liver of pregnancy are extremely rare but represent a serious complication as a life-threatening condition for both the mother and newborn in late-term pregnancy. Preoperatively, adequate management with multidisciplinary teams and timely delivery are potentially required to save materno-fetal life. Herein, we report a rare, inconspicuous case of acute fatty liver of pregnancy in third-trimester pregnancy and a review of the literature to underscore this hazardous entity.

CASE PRESENTATION: A 28 year-old pregnant Vietnamese woman was transferred to our tertiary referral hospital for suspicion of acute fatty liver of pregnancy without prodromal signs, except for intermittent abdominal pain at 39 weeks 3 days of gestational age. In accordance with the Swansea criteria, laboratory findings contributed to confirming the diagnosis of acute fatty liver of pregnancy. Immediately, an emergent cesarean section was rapidly performed. Postoperatively, the patient recovered gradually with rapid improvement of biochemical and hematological parameters. The woman and her neonate were discharged uneventfully after 9 days of hospitalization.

CONCLUSIONS: Acute fatty liver of pregnancy may be asymptomatic and can progress quickly, affecting multiple organs. Early diagnosis is based on abnormal presentation of serum laboratory tests. In addition, clinicians ought to assess the diagnosis following the Swansea criteria. Importantly, supportive therapy, strict monitoring, and early termination of pregnancy, when appropriate, are still the mandatory protocols for the management of acute fatty liver of pregnancy.