ACUTE FATTY LIVER OF PREGNANCY - A CLINICAL-STUDY OF 12 EPISODES IN 11 PATIENTS

Twelve episodes of acute fatty liver of pregnancy (AFLP) were diagnose d in 11 patients during the past 18 years in a general hospital in San tiago, Chile, with a prevalence of 1 per 15 900 deliveries. Acute fatt y liver of pregnancy started between the 31st and 38th weeks of pregna ncy, with malaise, vomiting, jaundice, and lethargy as the main clinic al manifestations. Polydipsia (in nine episodes) and skin pruritus (in seven episodes) were unusual clinical findings. In two patients, prur itus started two and four weeks before AFLP, suggesting that;in intrah epatic cholestasis of pregnancy preceded AFLP in those patients. Consi dering the current prevalence of both diseases in Chile, their associa tion should be considered fortuitous. In another patient, two consecut ive pregnancies were affected by AFLP, raising to three the number of reported patients with recurrent AFLP. In 11 episodes, liver biopsies supported the diagnosis of AFLP by showing small and midsized vacuolar cytoplasmic transformation as the most prominent histopathological fe ature. Positive intracellular fat staining was found in the four sampl es analysed. Studies by electron microscopy showed megamitochondria wi th paracrystaline inclusions in four samples. All the mothers survived , but fetal mortality was 58.3%. Several extrahepatic complications de layed maternal recovery for up to four weeks after delivery. This stud y confirms an improvement in maternal prognosis in AFLP, discusses the possibility of an epidemiological association with intrahepatic chole stasis of pregnancy, and increases the number of patients reported wit h recurrent AFLP.