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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 438-441    DOI: 10.31083/j.ceog.2020.03.5222
Case Report Previous articles | Next articles
Acute fatty liver during pregnancy and gestational diabetes insipidus: a case report
H.J. Wang1, †, T.H. Chou2, †, Y.C. Lee1, H.K. Au1, 3, 4, *()
1Department of Obstetrics and Gynecology, Taipei Medical University Hospital, 11031 Taipei, Taiwan
2Department of Internal Medicine, Taipei Medical University Hospital, 11031 Taipei, Taiwan
3Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, 11031 Taipei, Taiwan
4Center for Reproductive Medicine, Taipei Medical University Hospital, 11031 Taipei, Taiwan
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Abstract  

Acute fatty liver during pregnancy (AFLP) is an emergency and potentially fatal condition occurring during the peripartum period. It is characterized by fatty microvascular infiltration of hepatocytes and has an incidence rate of approximately one in 7,000 to one in 20,000 pregnancies. It may induce profound liver failure and can be accompanied by renal failure, polydipsia/polyuria, disseminated intravascular coagulation, hypoglycemia, and encephalopathy. Emergency delivery at the appropriate time is crucial to control the development of AFLP. Gestational diabetes insipidus (GDI) is another rare disorder characterized by polyuria, polydipsia, and dehydration. It has an incidence rate of 2-4 cases/100,000 pregnancies and develops during the third trimester. Here the authors present the case of a patient with AFLP and transient GDI complicated with non-reassuring fetal status. The conditions were resolved after delivery and multidisciplinary intensive care.

Key words:  Acute fatty liver during pregnancy      Deamino arginine vasopressin      Fetal distress      Gestational diabetes insipidus      Pregnancy complications     
Submitted:  06 August 2019      Accepted:  16 October 2019      Published:  15 June 2020     
*Corresponding Author(s):  HENG-KIEN AU     E-mail:  hengkienau@gmail.com
About author:  Contributed equally.

Cite this article: 

H.J. Wang, T.H. Chou, Y.C. Lee, H.K. Au. Acute fatty liver during pregnancy and gestational diabetes insipidus: a case report. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 438-441.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5222     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/438

Table 1  — Criteria for diagnosis of AFLP. Six or more of the above features in the absence of other liver diseases of pregnancy
Vomiting
Abdominal pain
Polydipsia/polyuria
Encephalopathy
Elevated bilirubin (>0.8 mg/dL)
Hypoglycemia (<72 mg/dL)
Elevated uric acid (>5.7 mg/dL)
White blood cell count (>11×10 3/μL)
Ascites or “Bright liver” on ultrasound
Elevated transaminases (aspartate aminotransferase or alanine aminotransferase >42 IU/L)
Elevated ammonia (>47 μ mol/L)
Renal impairment (creatinine >1.7 mg/dL )
Coagulopathy (prothrombin time >14 s or activated partial thromboplastin time >34 s)
Microvesicular steatosis on liver biopsy
Figure 1.  — Diffuse heteroechogenicity, moderate fatty change of the liver parenchyma, and a small amount of ascites (arrows).

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