Acute liver failure in pregnancy due to autoimmune hepatitis

Abstract

Autoimmune hepatitis is a diagnosis rarely made in pregnancy, especially in the setting of acute liver failure. If unrecognised and untreated, it can result in significant fetal and maternal morbidity and mortality. We report a case of acute liver failure in a patient presenting at 17 weeks’ gestation. She was diagnosed with autoimmune hepatitis via transjugular liver biopsy. Prednisone therapy was initiated, resulting in disease remission for the remainder of her pregnancy. Induction of labour at 37 weeks’ gestation resulted in delivery of a healthy small for gestational age neonate. Prompt diagnosis of a non-obstetrical aetiology for acute liver failure in pregnancy is critical to provide the appropriate therapy to achieve an optimal pregnancy outcome.

Autoimmune hepatitis in pregnancy: Pearls and pitfalls

“…[27][28][29] Two different reports of new onset AIH with acute liver failure (ALF) showed one patient requiring LT at 18 weeks gestation, whereas the other patient responded to corticosteroids and had induced labor at 37 weeks, delivering a small for gestational age (SGA) infant. [29,30] In another study, a patient with no known liver disease had an IVF pregnancy and suffered with an index presentation of hepatic decompensation in the second trimester, which resulted in an emergency CS at 28 weeks. [27] The child developed severe mental and physical developmental delays.…”