"acute fatty liver of pregnancy and preeclampsia in a triplet gestation "

acute fatty liver of pregnancy (aflp) is a rare entity and a potentially fatal disorder. it is reported to be more common in multiple than singleton pregnancies. sometimes it coincides with preeclampsia but the exact etiology is not yet understood. a 31-year-old g2 p1 patient admitted at 33 weeks of pregnancy with signs and symptoms of jaundice, gastroenteritis, hypertension, malaise, urinary incontinence and preterm contractions. she had history of idiopathic hypothalamic amenorrhea and by a recent trial with gonadotropins, she had got triplet gestation. after admission her general condition deteriorated. she underwent cesarean section at once and all fetuses survived. she had severe postpartum hemorrhage. the results of laboratory tests indicated coagulopathy and liver function abnormalities. the aflp was diagnosed on the third day of hospital stay. she was discharged one week later. again she returned with complaint of severe sustained headache. computed tomography showed subdural hemorrhage and drainage of hematoma was performed immediately. finally the patient recovered from all of these critical conditions. this is the first report of aflp in a patient with history of idiopathic hypothalamic amenorrhea. aflp should be suspected in every pregnant patient with preeclampsia and gastroenteritis symptoms in the third trimester of pregnancy.