Acute Liver Failure in Pregnancy for Lower Segment Caesarean Section with Favourable Maternal and Neonatal Outcomes - A Case Report and Review of Literature

Abstract

Acute liver failure (ALF) during pregnancy has a detrimental impact on both maternal and foetal outcomes. The spectrum of liver disease in pregnancy can vary from mild, asymptomatic elevation of liver enzymes to severe, irreversible liver dysfunction, resulting in significant complications and even death. Hepatitis A virus related ALF generally has a favourable prognosis, with approximately 70% of cases resolving spontaneously. However, a remaining 30% may have severe morbidity with a few cases even requiring liver transplant. Therapeutic plasma exchange has been found to lower circulating inflammatory cytokine levels, stabilize hemodynamics, and enhance transplant-free survival in ALF. A well trained multidisciplinary team plays a vital role in ensuring success. A prompt decision to perform a cesarean section is crucial, as it offers the best chance of survival for both mother and baby. Although hepatitis A is mostly non-fatal, the likelihood of a successful outcome at near term of pregnancy especially when presented with ALF is lower. We recently had a case of ALF in near term pregnancy with both mother and neonate surviving due to intense perioperative management. We report this case to highlight the role of perioperative management and plasma exchange in achieving favorable outcomes.