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Maternal Medicine Posters
An interesting presentation of acute liver failure in pregnancy - a case report
  1. A Alzouebi,
  2. S Syed,
  3. E Horner,
  4. T Amin
  1. St Mary's Hospital, London, United Kingdom

Abstract

Acute liver failure in pregnancy is associated with significant morbidity and mortality. Often it can be challenging to diagnose and manage. This can be as a result of overlapping symptoms and signs of conditions specific to pregnancy related liver disease such as, obstetric cholestasis, pre-eclampsia and acute fatty liver.1 Acute fatty liver (AFL) of pregnancy and Obstetric cholestasis typically occurs in the third trimester.

We present a case of a 31year old, Asian primigravida, whom presented with itching at 30 weeks gestation. Investigations revealed normal liver ultrasound scan, negative hepatitis screen, and normal bile acids and raised ALT of 116. A diagnosis of obstetric cholestasis was made. At 37 weeks gestation, the patient went on to develop significant pre-eclampsia and was delivered by emergency caesarean section. Immediately post delivery the patient developed acute liver and renal failure with persistent hypoglycaemia. A diagnosis of acute hepato-renal failure was made. The patient went on to make a full recovery.

This case highlights the potential catastrophic sequelae to mother and newborn with acute liver disease. Prompt diagnosis, early involvement of a multi-disciplinary team and management in a critical care unit is vital for good prognosis.

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