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Idiopathic acute fatty liver of pregnancy in 12 patients.
Q J Med. 1982; 51(204):481-97.QJ

Abstract

The clinical features, laboratory investigations and histopathology of 12 patients with idiopathic acute fatty liver of pregnancy are presented. Repeated vomiting, starting in the last trimester, was the cardinal symptom. Seven patients had proteinuria, hypertension and peripheral oedema before jaundice appeared. Caesarian section and induction of labour led to a lower than expected maternal mortality (33 X 3 per cent) and foetal mortality (66 X 7 per cent). There was a high incidence of twin and male births. Neutrophilia, thrombocytopenia and normoblasts were a uniform feature and uric acid levels were universally high. These findings may be useful in diagnosis in conjunction with liver function tests. Hepatic histology showed pathognomonic microvesicular fat in swollen hepatocytes with central nuclei and centrilobular distribution. However, a diffuse pattern and the presence of significant inflammation and fibrin deposits led to an initial misdiagnosis in two patients. Histology of fetal livers and five placentae was normal. Seven subsequent normal pregnancies occurred in four patients. Acute fatty liver of pregnancy may be confused with acute hepatitis or toxaemia on both clinical and histological grounds. Accurate diagnosis should lead to improved management and lessen maternal and fetal mortality. This justifies more intensive and urgent investigation of nausea, vomiting and jaundice in the last trimester of pregnancy.

Authors

Burroughs AK
No affiliation info available
Seong NH
No affiliation info available
Dojcinov DM
No affiliation info available
Scheuer PJ
No affiliation info available
Sherlock SV
No affiliation info available

MeSH

Acute DiseaseAdultFatty LiverFemaleFetal DeathHumansLiverPregnancyPregnancy ComplicationsPregnancy Trimester, ThirdPuerperal Disorders

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7156326

Citation

Burroughs, A K., et al. "Idiopathic Acute Fatty Liver of Pregnancy in 12 Patients." The Quarterly Journal of Medicine, vol. 51, no. 204, 1982, pp. 481-97.
Burroughs AK, Seong NH, Dojcinov DM, et al. Idiopathic acute fatty liver of pregnancy in 12 patients. Q J Med. 1982;51(204):481-97.
Burroughs, A. K., Seong, N. H., Dojcinov, D. M., Scheuer, P. J., & Sherlock, S. V. (1982). Idiopathic acute fatty liver of pregnancy in 12 patients. The Quarterly Journal of Medicine, 51(204), 481-97.
Burroughs AK, et al. Idiopathic Acute Fatty Liver of Pregnancy in 12 Patients. Q J Med. 1982;51(204):481-97. PubMed PMID: 7156326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Idiopathic acute fatty liver of pregnancy in 12 patients. AU - Burroughs,A K, AU - Seong,N H, AU - Dojcinov,D M, AU - Scheuer,P J, AU - Sherlock,S V, PY - 1982/1/1/pubmed PY - 1982/1/1/medline PY - 1982/1/1/entrez SP - 481 EP - 97 JF - The Quarterly journal of medicine JO - Q J Med VL - 51 IS - 204 N2 - The clinical features, laboratory investigations and histopathology of 12 patients with idiopathic acute fatty liver of pregnancy are presented. Repeated vomiting, starting in the last trimester, was the cardinal symptom. Seven patients had proteinuria, hypertension and peripheral oedema before jaundice appeared. Caesarian section and induction of labour led to a lower than expected maternal mortality (33 X 3 per cent) and foetal mortality (66 X 7 per cent). There was a high incidence of twin and male births. Neutrophilia, thrombocytopenia and normoblasts were a uniform feature and uric acid levels were universally high. These findings may be useful in diagnosis in conjunction with liver function tests. Hepatic histology showed pathognomonic microvesicular fat in swollen hepatocytes with central nuclei and centrilobular distribution. However, a diffuse pattern and the presence of significant inflammation and fibrin deposits led to an initial misdiagnosis in two patients. Histology of fetal livers and five placentae was normal. Seven subsequent normal pregnancies occurred in four patients. Acute fatty liver of pregnancy may be confused with acute hepatitis or toxaemia on both clinical and histological grounds. Accurate diagnosis should lead to improved management and lessen maternal and fetal mortality. This justifies more intensive and urgent investigation of nausea, vomiting and jaundice in the last trimester of pregnancy. SN - 0033-5622 UR - https://www.unboundmedicine.com/medline/citation/7156326/Idiopathic_acute_fatty_liver_of_pregnancy_in_12_patients_ L2 - http://www.diseaseinfosearch.org/result/5922 DB - PRIME DP - Unbound Medicine ER -