STUDY OF THE LIVER CHANGES OCCURRING IN PREECLAMPSIA AND THEIR POSSIBLE PATHOGENETIC CONNECTION WITH ACUTE FATTY LIVER OF PREGNANCY

Objective: The objective of the present study was to investigate liver involvement in preeclampsia on the basis of clinical, laboratory, and histological data and to detect a possible connection with fatty live r of pregnancy by the determination of microvesicular fatty infiltrati on of the liver. Methods: The authors studied the liver changes in 10 patients with preeclampsia, observing the clinical and laboratory alte rations, the macroscopic liver surface features by laparoscopy, and th e presence of microvesicular fatty infiltration by specific lipid stai ning of hepatic tissue collected by needle biopsy. Results: Macroscopy of the liver surface disclosed some degree of subcapsular liver hemor rhage in all cases; however, the hemorrhage was not related to the cli nical and histological severity of the disease. Microvesicular fat dro plets were observed in all patients, and the intensity of the fat depo sition was not related to presser levels, laboratory alterations, or t he evolution of preeclampsia. Conclusions: The presence of fatty liver infiltration in all patients studied supports the idea that preeclamp sia and acute fatty liver of pregnancy could be components of the same pathologic spectrum, with a probable, but still unproved, pathogeneti c connection. The deficiency of the long chain 3-hydroxyacyl-coenzyme A dehydrogenase activity may be the determining factor in the evolutio n of the disease.