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Acute fatty liver of pregnancy associated with pancreatitis: a life-threatening complication.
Am J Obstet Gynecol. 2004 Feb; 190(2):502-5.AJ

Abstract

OBJECTIVE

Inadequate data describe pancreatitis as a complication in women with acute fatty liver of pregnancy. Our purpose was to report our experience with this complication, which included maternal and perinatal outcomes.

STUDY DESIGN

Medical records of patients with acute fatty liver of pregnancy and/or pancreatitis were reviewed over a 15-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes.

RESULTS

Persistent nausea and vomiting were the symptoms in 10 of 12 patients (83%). The average maternal age was 26.3 years (range, 21-37 years). There were two maternal deaths (17%); one death occurred despite liver transplantation. Maternal morbidity included encephalopathy (50%), acute respiratory distress syndrome (17%), and renal failure (33%) that resulted from acute tubular necrosis (3 cases) and acute cortical necrosis (1 case) that required renal transplantation. Of the 12 patients, 11 patients (91%) had an elevated serum lipase level, and another patient had an elevated serum amylase level (9%). Eight of 12 patients (67%) underwent radiologic studies, of which 7 patients (88%) were diagnostic for pancreatitis. Radiographic and autopsy findings noted pancreatic inflammation (3 cases), pseudocyst formation (3 cases), and hemorrhagic pancreatitis (1 case). The radiographic and serum laboratory abnormalities occurred after the onset of hepatic and renal abnormalities in all cases.

CONCLUSION

Pancreatitis is a potentially lethal complication of acute fatty liver of pregnancy, and all patients with this diagnosis should undergo screening for the abnormality. Pancreatic abnormalities typically appear after hepatic and renal dysfunction.

Authors+Show Affiliations

Moldenhauer JS
Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
O'brien JM
No affiliation info available
Barton JR
No affiliation info available
Sibai B
No affiliation info available

MeSH

Acute DiseaseAdultAmylasesDisease ProgressionFatty LiverFemaleHumansPancreatitisPregnancyPregnancy ComplicationsPregnancy OutcomeRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14981397

Citation

Moldenhauer, Julie S., et al. "Acute Fatty Liver of Pregnancy Associated With Pancreatitis: a Life-threatening Complication." American Journal of Obstetrics and Gynecology, vol. 190, no. 2, 2004, pp. 502-5.
Moldenhauer JS, O'brien JM, Barton JR, et al. Acute fatty liver of pregnancy associated with pancreatitis: a life-threatening complication. Am J Obstet Gynecol. 2004;190(2):502-5.
Moldenhauer, J. S., O'brien, J. M., Barton, J. R., & Sibai, B. (2004). Acute fatty liver of pregnancy associated with pancreatitis: a life-threatening complication. American Journal of Obstetrics and Gynecology, 190(2), 502-5.
Moldenhauer JS, et al. Acute Fatty Liver of Pregnancy Associated With Pancreatitis: a Life-threatening Complication. Am J Obstet Gynecol. 2004;190(2):502-5. PubMed PMID: 14981397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute fatty liver of pregnancy associated with pancreatitis: a life-threatening complication. AU - Moldenhauer,Julie S, AU - O'brien,John M, AU - Barton,John R, AU - Sibai,Baha, PY - 2004/2/26/pubmed PY - 2004/3/31/medline PY - 2004/2/26/entrez SP - 502 EP - 5 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 190 IS - 2 N2 - OBJECTIVE: Inadequate data describe pancreatitis as a complication in women with acute fatty liver of pregnancy. Our purpose was to report our experience with this complication, which included maternal and perinatal outcomes. STUDY DESIGN: Medical records of patients with acute fatty liver of pregnancy and/or pancreatitis were reviewed over a 15-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes. RESULTS: Persistent nausea and vomiting were the symptoms in 10 of 12 patients (83%). The average maternal age was 26.3 years (range, 21-37 years). There were two maternal deaths (17%); one death occurred despite liver transplantation. Maternal morbidity included encephalopathy (50%), acute respiratory distress syndrome (17%), and renal failure (33%) that resulted from acute tubular necrosis (3 cases) and acute cortical necrosis (1 case) that required renal transplantation. Of the 12 patients, 11 patients (91%) had an elevated serum lipase level, and another patient had an elevated serum amylase level (9%). Eight of 12 patients (67%) underwent radiologic studies, of which 7 patients (88%) were diagnostic for pancreatitis. Radiographic and autopsy findings noted pancreatic inflammation (3 cases), pseudocyst formation (3 cases), and hemorrhagic pancreatitis (1 case). The radiographic and serum laboratory abnormalities occurred after the onset of hepatic and renal abnormalities in all cases. CONCLUSION: Pancreatitis is a potentially lethal complication of acute fatty liver of pregnancy, and all patients with this diagnosis should undergo screening for the abnormality. Pancreatic abnormalities typically appear after hepatic and renal dysfunction. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/14981397/Acute_fatty_liver_of_pregnancy_associated_with_pancreatitis:_a_life_threatening_complication_ DB - PRIME DP - Unbound Medicine ER -