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Han, Seo, and Im: Acute fatty liver of pregnancy with fetal microvesicular hepatic steatosis
Case Report
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(9): 649-654.

Published online: 17 September 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.9.649

Acute fatty liver of pregnancy with fetal microvesicular hepatic steatosis

Woo-Suk Han, MD, Yong Soo Seo, MD, Seung Yeon Im, MD

Department of Obstetrics and Gynecology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.

Corresponding author: Yong Soo Seo, MD. Department of Obstetrics and Gynecology, Eulji Hospital, Eulji University School of Medicine, 14 Hangeulbiseok-gil, Nowon-gu, Seoul 139-872, Korea. Tel: +82-2-970-8245, Fax: +82-2-970-8231, obdrseo@naver.com

Received 22 April 2012       Revised 16 June 2012       Accepted 16 July 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute fatty liver of pregnancy (AFLP) is a serious maternal disease occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. Until recently the pathogenesis of AFLP was unknown and still has not been fully elucidated. However, recent molecular advances suggest that AFLP may result from mitochondrial dysfunction. Several reports have documented a strong association between AFLP and a deficiency of the enzyme long-chain 3-hydroxyacyl-CoA dehydrogenase in the fetus, a disorder of mitochondrial fatty acid beta-oxidation. Therefore in this case, through findings of liver biopsy from dead fetus, we report possible causal relationship between fetal liver disease and maternal AFLP with literature reviews.

Keywords: Acute fatty liver of pregnancy, Fatty liver, Long-chain 3-hydroxyacyl-CoA dehydrogenase

Figures and Tables

Fig. 1
Microscopic findings of liver biopsy of dead fetus (Gram stain). (A) Low-power view (×100). (B) High-power view (×200). There are diffuse parenchymal hemorrhage with focal hemorrhagic infarction and microvesicular fatty metamorphosis (steatosis).
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Fig. 2
Hypothesis illustrating the possible role of fetal and maternal MTP mutations in developing AFLP. Carrying an LCHAD deficient fetus (A) is the major determining factor in the development of maternal illness. Hepatotoxic metabolites produced by the fetus and/or placenta may cause liver disease in the obligate heterozygous mother when combined with the metabolic stress of the third trimester. Environmental stress (B) may lead to the further accumulation of toxic metabolites in the genetically susceptible mother causing maternal liver disease. LCHAD, long-chain 3-hydroxyacyl-CoA dehydrogenase; AFLP,acute fatty liver of pregnancy; MTP, mitochondrial trifunctional protein. (From Ibdah. World J Gastroenterol 2006;12:7397-404 [15]).
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Table 1
Serial laboratory results
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HD, hospital day; PPD, postpartum day; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase; ALP, alkaline phosphatase; PTT, partial thromboplastin time; PT, prothrombin time; INR, international normalized ratio; WBC-Hb-Plt, white blood cell-hemoglobin-platelet; FDP, fibrinogen degradation product; r-GTP, gamma-glutamyl transpeptidase; CPK, creatine phosphokinase.

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