Skip to main content Skip to main navigation menu Skip to site footer

Acute fatty liver of pregnancy: a case report


Introduction: Acute fatty liver of pregnancy (AFLP) is rare but potentially lethal complication. AFLP characterized by microvascular fatty infiltration of hepatocytes without any inflammation or necrosis.

Case Presentation: A 37-year-old multigravida with 29 weeks period of gestation came with chief complains of acute jaundice, nausea, malaise and anorexia since 7 days ago. On examination, her eyes were icteric and her motor power was decreased on both extremities. Abdominal examination showed fetus in cephalic presentation with normal fetal heart rate. There was no opening and effacing of cervix. The ECG result showed prolonged QT interval. She had elevated liver enzyme, decreased renal function, electrolyte imbalance, hypoalbuminemia and hypercholesterolemia. Abdominal ultrasound was within normal limit. Patient was then assessed with differential diagnosed of AFLP, acute hepatitis and HELLP syndrome. She was treated conservatively with ferrous sulfate, high carbohydrate diet, KSR once daily, CDR once daily and Bisoprolol 1.25mg once daily.  Three months later patient delivered a healthy baby boy via caesarian section due to premature rupture of membrane.

Conclusion: Since AFLP is a medical and obstetric emergency, early recognition and prompt treatment improves both maternal and fetal survival.


  1. Hin Hin Ko EY. Acute fatty liver of pregnancy. Gastroenterology. 2006;20(1):25–30.
  2. Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. A prospective national study of acute fatty liver of pregnancy in the UK. 2008;951–6.
  3. Rajasri AG, Srestha R, Mitchell J. Acute fatty liver of pregnancy ( AFLP ) – an overview. J Obstet Gynaecol (Lahore). 2007;27(April):237–40.
  4. Ibdah JA. Acute fatty liver of pregnancy : An update on pathogenesis and clinical implications. World J Gastroenterol. 2006;12(46):7397–404.
  5. Knox T, Olans L. Liver Disease in Pregnancy. N Engl J Med. 2013;569–76.
  6. Wilcken B, Leung K, Hammond J. Pregnancy and fetal long-chain dehydrogenase deficiency. Lancet. 2010;(341):407–8.
  7. Lee WS, Sokol RJ. Liver Disease in Mitochondrial Disorders. Semin Liver Dis. 2012;27(3):22–30.
  8. Strauss AW, Bennett M, Rinaldo P, Sims HF, Brien LKO, Zhao Y, et al. Inherited Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency and a Fetal- Maternal Interaction Cause Maternal Liver Disease and Other Pregnancy Complications. Semin Perinatol. 2011;23(2):100–12.
  9. Reyes H, Sandoval L, Wainstein A, Ribalta J, Donoso S, Smok G, et al. Acute Fatty Liver of Pregnancy: a Clinical Study of 12 Episodes in 11 Patients. BMJ Case Rep. 2010;35:101–6.
  10. Ventura F, Ruiter J, Ijlst L. Inhibitory effect of 3-hydroxyacyl-CoAs and other long-chain fatty acid ] J-oxidation intermediates on mitochondrial oxidative phosphorylation. J Inherit Metab Dis. 2006;19:161–4.
  11. Natarajan SK, Thangaraj KR, Eapen CE, Ramachandran A, Mukhopadhya A, Mathai M, et al. Liver Injury in Acute Fatty Liver of Pregnancy : Possible Link to Placental Mitochondrial Dysfuntion and Oxidative Stress. J Hepatol. 2010;51(1):191–200.
  12. Castro MA, Fassett MJ, Reynolds TB, Shaw KJ, Goodwin TM. Reversible peripartum liver failure : A new perspective on the diagnosis , treatment , and cause of acute fatty liver of pregnancy , based on 28 consecutive cases. Am J Obstet Gynocology. 2010;389–95.
  13. Fesenmeier MF, Coppage KH, Lambers DS, Barton JR, Sibai BM. Acute fatty liver of pregnancy in 3 tertiary care centers. Am J Obstet Gynocology. 2015;1416–9.
  14. Laurie J, Morton A. Physiological changes of pregnancy and the Swansea criteria in diagnosing acute fatty liver of pregnancy. Obstet Med. 2018;2(1):22–6.
  15. Burroughs A, Seong N, Dojcinov D, Scheuer P, Sherlock S. Idiopathic Acute Fatty Liver of Pregnancy in 12 Patients. Q J Med. 2016;51:481–97.
  16. Holzbach R. Acute fatty liver of pregnancy with disseminated intravascular coagulation. Obstet Med. 2016;43(5):740–5.
  17. MA C, Colletti O, KJ S, SM S, TM G. Radiologic studies in acute fatty liver of pregnancy. A review of the literature and 19 new cases. J Reprod Med. 2015;41(11):839–43.
  18. Vigil-de Gracia P. Acute fatty liver and HELLP syndrome : two distinct pregnancy disorders. Int J Gynaecol Obstet. 2011;73:215–20.
  19. Moldenhauer JS, Brien JMO, Barton JR, Sibai B. Acute fatty liver of pregnancy associated with pancreatitis : A life-threatening complication. Am J Obstet Gynocology. 2010;190:502–5.
  20. Suzuki S, Watanabe S, Araki T. Acute fatty liver of pregnancy at 23 weeks of gestation. Br J Obstet Gynaecol. 2011;108(February):223–4.

How to Cite

Mahardika, P. G. A. S., Prabawa, A., & Suardana, K. (2020). Acute fatty liver of pregnancy: a case report. Intisari Sains Medis, 11(2), 835–838.




Search Panel

Putu Gede Agus Surya Mahardika
Google Scholar
ISM Journal

Aditya Prabawa
Google Scholar
ISM Journal

Ketut Suardana
Google Scholar
ISM Journal