DISSEMINATED INTRAVASCULAR COAGULATION AND ANTITHROMBIN-III DEPRESSION IN ACUTE FATTY LIVER OF PREGNANCY

OBJECTIVE: Acute fatty liver of pregnancy has been associated with a s yndrome of marked depression of antithrombin III and disseminated intr avascular coagulation. We sought to identify the clinical importance o f this accelerated coagulation. STUDY DESIGN: The medical records of p atients with acute fatty liver of pregnancy identified during the peri od of 1982 to 1994 were retrospectively reviewed. RESULTS: Twenty-eigh t patients with acute fatty liver of pregnancy were identified for an incidence of 1:6692 births. Laboratory evidence of persistent dissemin ated intravascular coagulation was found in ail patients tested. Six p atients had clinical bleeding, ail associated with genital tract injur y. Twenty-three of twenty-three patients tested had markedly decreased antithrombin III levels (average 11%, normal range 80% to 100%). Seve n patients received antithrombin III transfusions, which was associate d with a significant transient rise in the plasma level. Compared with patients not transfused, however, there was a similar clinical outcom e. CONCLUSION: Profoundly depressed antithrombin III levels and labora tory evidence of disseminated intravascular coagulation were present i n all cases of acute fatty liver of pregnancy but rarely influenced cl inical outcome unless there was concomitant genital tract injury. Anti thrombin III transfusions increased plasma levels, but no definite cli nical benefit was established in this series because of the small numb er of cases.