A Twin Pregnant Woman Presented with Jaundice in the Third Trimester Complicated by Acute Fatty Liver of Pregnancy

Abstract

<p>妊娠急性脂肪肝是一種發生在妊娠晚期罕見但致命性的疾病，一旦發病直接威脅到孕婦與胎兒的生命安全。本案例是一位31歲雙胞胎孕婦，在妊娠36週+3天出現食慾不振、噁心嘔吐、右上腹痛及黃疸現象，隨後發生胎兒窘迫需盡快生產，經緊急剖腹順利產下二名男嬰，產後轉加護病房照顧。此病症依據臨床症狀、妊娠週數、實驗室數據，經排除相關疾病並應用Swansea criteria診斷為妊娠急性脂肪肝，在提供支持性治療，肝功能逐漸回復正常，病況穩定順利出院。因此，一旦高度懷疑或確立為妊娠急性脂肪肝，均須盡快終止妊娠，避免病情驟然加劇，導致進一步肝功能衰竭，以降低雙方併發症和死亡率。</p> <p> </p><p>Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening complication occurring in the third trimester. It is often fatal to both mother and fetus. This case is a 31-year-old pregnant woman with twins who developed loss of appetite, nausea and vomiting, right upper quadrant pain and jaundice before 37 weeks of gestation, followed by fetal distress and needed to be delivered as soon as possi-ble. Two male babies were successfully delivered by emergency caesarean section and the patient was transferred to the intensive care unit after delivery. Based on clinical symptoms, gestational weeks, and laboratory data, acute fatty liver of pregnancy was diagnosed by excluding related diseases and applying Swansea criteria evaluation. After providing supportive treatments, the liver function gradu-ally returned to normal, and the condition was stable, and the patient was then discharged. Therefore, once acute fatty liver of pregnancy is highly suspected or established, the pregnancy must be terminat-ed as soon as possible to avoid the sudden aggravation of the condition and lead to further liver failure, so as to reduce further complications and mortality rates.</p> <p> </p>