Maternal Death due to Acute Fatty Liver of Pregnancy

Jeong-Hwa Kwon, Misun Choi, Hongil Ha, Sohyung Park
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Abstract

A pregnant woman has to adapt to various physiologic changes which follows growing and delivering a baby. In other words, a serious complication can occur in physiologic changes that may give a rise to maternal or fetal mortality if these physiologic changes are maladjusted. Maternal mortality can be an important issue in forensic pathology as well as in public health because, if an unexpected maternal death occurs despite prenatal care having been performed, it may be embroiled in a medicolegal dispute. Acute fatty liver of pregnancy (AFLP) is a characteristic liver disease associated with pregnancy that can cause death in both mother and fetus [1]. The diagnosis of AFLP usually should be based on clinical presentation with consistent laboratory results and imaging studies. However, if the mother doesn’t show any significant symptoms related to AFLP, or if AFLP is not clinically suspicious and as a result no further evaluation are performed, the diagnosis is not easy to make. In addition, the maternal mortality of AFLP was reported as approximately 18% [1] but lethal cases of AFLP are not well known. In this case report, we illustrated a sudden death case of maternal death of AFLP and we reviewed postmortem findings with literature. Korean J Leg Med 2017;40:141-144 https://doi.org/10.7580/kjlm.2017.41.4.141
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妊娠期急性脂肪肝导致的产妇死亡
孕妇必须适应生长和分娩后的各种生理变化。换句话说,严重的并发症可能发生在生理变化,如果这些生理变化是失调的,可能会导致产妇或胎儿死亡。产妇死亡率在法医病理学和公共卫生领域都是一个重要问题,因为如果产妇在进行产前护理后意外死亡,可能会引起医学法律纠纷。急性妊娠脂肪肝(Acute fatty liver of pregnancy, AFLP)是一种与妊娠相关的特征性肝脏疾病,可导致母胎双方死亡[1]。AFLP的诊断通常应基于临床表现、一致的实验室结果和影像学检查。然而,如果母亲没有表现出任何与AFLP相关的明显症状,或者如果临床上没有怀疑AFLP,因此没有进行进一步的评估,则不容易做出诊断。此外,AFLP的孕产妇死亡率据报道约为18%[1],但AFLP的致死病例尚不清楚。在本病例报告中,我们说明了一例AFLP产妇猝死病例,并回顾了尸检结果与文献。中华医学杂志2017;40:141-144 https://doi.org/10.7580/kjlm.2017.41.4.141
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