Acute Liver Failure In Pregnancy

Acute liver disease presenting as jaundice is a common event occurring in pregnancy occurring in about 1 per 1000 deliveries. The most common cause of jaundice in pregnancy is viral hepatitis. In the developed world viral hepatitis causes about 2/3 s of cases of jaundice in several series. [1] The great majority of viral hepatitidies are of slow onset and course. They are rarely associated with fulminant liver failure. This is an article about fulminant liver failure in pregnancy. This is extremely rare in Western medicine and there are few references, this is an attempt to develop guidelines to guide diagnosis and treatment. an unengaged vertex presentation. Her extremities are normal and move normally. Her cervix is 1 cm dilated soft -2 station with intact membranes. There is no bruising or bleeding from her IV site, gums, or vagina. The FHR, fetal heart rate tracing, is normal. Routine labs for pregnancy and jaundice have been ordered. The bulbar palsy is a sign of worsening myasthenia, neurology is consulted. The neurologist finds minimal but generalized muscle weakness except for bulbar muscles which are moderately weak and recommends resumption of her previous oral corticosteroid. She receives IV corticosteroids because of two corticosteroid treatment courses in the last 6 months The patient’s laboratory workup has returned with the WBC is of 13,000 with slight eosinophilia, bands of 5% and metamyelocytes of 4%, a normal platelet size and morphology with a count of 317,000, a mild normochromic anemia consistent with her past values and no evidence of DIC, disseminated intravascular coagulation. Her urinalysis is normal, AST is 2435, ALT is 1634. Total bilirubin is 8.5 (NL 0.2 to 1.0), direct bilirubin is 2.9 (NL ~ 0). Her albumin is 2.4 grams and A/G ratio is 0.6. Glucose and electrolytes are normal, BUN is 6, serum creatinine 0.6. Uric acid 4.3. (NL 3.5 to 7.0) Amylase and lipase are normal. Ammonia level 48 (NL 1132). Fibrinogen 120 mg%. PT. 60, corrected INR of 1.5. PTT is 68 both moderately high, both possibly from reduced fibrinogen production. A urinalysis is normal with no proteinuria and a urobilogen of 0.2. Two hours later patient develops tachycardia, sweating and change in her mentation over a few minutes. An EKG was normal, a finger stick for glucose was 40 mg%. 5% dextrose infusion resolved her symptoms within a few minutes. An ultrasound of both her fetus and her liver are performed. The fetal ultrasound is normal with normal estimated fetal weight, normal amniotic fluid, a reactive NST, non-stress test, and normal Doppler of UA, umbilical artery flow, giving a modified biophysical of 4 of 4. Her liver shows a contracted gallbladder from a meal 2 hours previously but multiple calcified gallstones. Her liver looks normal including size, texture, and bile duct size. There is no evidence of sub capsular hemorrhage, cirrhosis, enlargement or common bile duct obstruction. The Doppler studies of the liver are normal. Internal Medicine and Gastroenterology are consulted to assist with her care. Since she is term there is no reason to delay labor but no immediate need for an immediate cesarean section. Clinical Case This is a collage of several patients and does not exactly represent any particular person or event.