Acute Fatty Liver in Twin Pregnancy

Abstract

Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal complication of late pregnancy. Various conditions such as haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome can produce hepatic impairment. The liver dysfunction associated with AFLP can cause significant hypoglycaemia and raised ammonia levels, which may help to distinguish it from pre-eclampsia and the HELLP syndrome. We present an atypical case of AFLP in a twin pregnancy who presented with severe hepatic and renal impairment, severe coagulopathy leading to hepatic coma and adult respiratory distress syndrome. There was no hypoglycaemia at presentation and the serum ammonia level was not high, indicating that the diagnosis of AFLP cannot be excluded just because these two aforementioned features are absent.