Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, China.
Medicine (Baltimore). 2021 Apr 23;100(16):e25524. doi: 10.1097/MD.0000000000025524.
Acutefatty liver of pregnancy (AFLP) is a potentially fatal obstetric emergency characterized by acute hepatic failure secondary to fatty infiltration. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Pancreatitis has been suggested as a poor prognostic indicator because it is associated with more adverse outcomes.
A 29-year-old Chinese woman at 34.7 weeks pregnancy was admitted to hospital due to paroxysmal hypogastric pain and massive colporrhagia for 1 day.
Laboratory tests revealed hepatic and renal impairment, coagulopathy. Thoracoabdominal computed tomography (CT) scanning showed pleural and peritoneal effusion, fatty liver, and pancreatitis. She was diagnosed with AFLP, severe acute pancreatitis (SAP), multiple organ dysfunction syndrome (MODS), and intrauterine fetal death.
The patient was treated with blood component transfusions, plasma exchange combined with renal replacement therapy, antibiotic de-escalation, gastric and pancreatic secretion inhibitor, and enteral nutrition.
After successful management, the patient was discharged without any complications on day 35 of admission. At 10 months follow-up, thoracoabdominal enhanced CT revealed was normal and laboratory tests revealed normal liver and kidney function.
Once AFLP is highly suspected or confirmed, the pregnancy should be terminated in time and active symptomatic management should be given.
妊娠急性脂肪肝（AFLP）是一种潜在致命的产科急症，其特征为脂肪浸润导致急性肝衰竭。由此产生的影响包括凝血功能障碍、电解质异常和多器官功能障碍。胰腺炎通常在肾功能和肝功能衰竭后发生。胰腺炎被认为是预后不良的指标，因为它与更多不良结局相关。
一名 29 岁的中国女性，妊娠 34.7 周，因阵发性下腹疼痛和大量阴道出血 1 天入院。
实验室检查显示肝肾功能损害、凝血功能障碍。胸腹 CT 扫描显示胸腔和腹腔积液、脂肪肝和胰腺炎。她被诊断为 AFLP、重症急性胰腺炎（SAP）、多器官功能障碍综合征（MODS）和宫内胎儿死亡。
患者接受了血液成分输血、血浆置换联合肾脏替代治疗、抗生素降级、胃和胰腺分泌抑制剂以及肠内营养治疗。
经成功治疗，患者于入院第 35 天无任何并发症出院。在 10 个月的随访中，胸腹增强 CT 显示正常，实验室检查显示肝肾功能正常。
一旦高度怀疑或确诊 AFLP，应及时终止妊娠，并给予积极的对症治疗。
