Clinical features:
(1) The onset is in the third trimester, often after the 30th week of gestation.
(2) It is more common in a primaparous woman or with a multiple gestation.
(3) The patient may present with nausea, vomiting, headache, fatigue, malaise or other flu-like symptoms.
(4) The patient may develop hypertension (with preeclampsia or eclampsia), abdominal pain, polyuria with polydipsia and jaundice.
(5) In severe cases the patient may develop multi-organ failure, with acute gastrointestinal hemorrhage, coagulopathy including DIC, hepatic encephalopathy, acute renal failure, and/or pancreatitis.
(6) Both the mother and fetus are at increased risk of mortality.
(7) Therapy includes early termination of pregnancy as soon as possible. A woman who survives often improves within 4 weeks of delivery.
Laboratory findings:
(1) conjugated hyperbilirubinemia
(2) moderate to marked elevation of serum AST and ALT
(3) marked elevation of serum alkaline phosphatase
(4) variable hypoglycemia
(5) serum LDH may be elevated but not as much as in HELLP since there is no hemolysis
(6) biochemical evidence of organ failures
Imaging studies such as CT may demonstrate diffuse steatosis but false negatives occur. Imaging studies are important for exclusion of conditions in the differential diagnosis.
Liver biopsy (if performed) shows diffuse microsteatosis.
