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Davidson Karen M. MD; Simpson, Lynn L. MD; Knox, Tamsin A. MD; D'Alton, Mary E. MD
Obstetrics & Gynecology: May 1998
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Background Acute fatty liver is reported to be more common in twin than in singleton pregnancies. We report three cases of biopsy-proven acute fatty liver in triplet gestations.

Cases In all three cases of acute fatty liver complicating triplet pregnancies, the presenting features were vague abdominal complaints with elevated hepatic aminotransferase levels. A liver biopsy was performed in each case, and cesareans were performed immediately after the diagnosis was confirmed histologically. Clinical resolution occurred in all cases, and all infants did well in the neonatal period.

Conclusion Patients with triplet gestations should be monitored closely for the early signs of acute fatty liver. Triplet gestations may contribute to the onset of acute fatty liver by further stressing the fatty acid oxidation capabilities of the susceptible woman.

Address reprint requests to: Karen M. Davidson, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail:

© 1998 The American College of Obstetricians and Gynecologists

Triplet gestations should be monitored closely for early evidence of acute fatty liver of pregnancy.