Pregnancy complicated by liver dysfunction: possible pathogenesis of vasospasm.

Abstract

Acute fatty liver of pregnancy, the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP), and severe preeclampsia form a disease spectrum. We report a case that showed a vasospastic phenomenon supported angiographically and hematologically. A 31-year-old Japanese woman presented at 37 weeks gestation with a 1-week history of nausea, vomiting and general fatigue. She underwent cesarean delivery for fetal distress. Liver dysfunction and disseminated intravascular coagulopathy were detected. The celiac angiogram showed vascular narrowing and irregularity of the vascular wall. Serum endothelin and the ratio of thromboxane B2 to 6-keto-prostaglandin F1 alpha were increased at the same time. The patient experienced rapid resolution of symptoms and laboratory abnormalities in the immediate postoperative period. A pregnancy complicated by liver dysfunction showed a vasospastic phenomenon, which may suggest the presence of a vasospastic syndrome.