Acute Fatty Liver Pregnancy


Abdomen | Obstetrics and Gynaecology | Acute Fatty Liver Pregnancy (Disease)


Description

Acute fatty liver of pregnancy (AFLP) is a serious complication characterized by microvesicular steatosis in the liver. Although the exact pathophysiology of AFLP is unknown it is unique to pregnancy. There does not appear to be a predilection for any geographical area or race. It is more common seen in primiparous women than multiparous women.

Symptoms include nausea and vomiting, abdominal pain, yellowing of the skin and eyes (jaundice), frequent thirst (polydipsia), increased urination (polyuria), headache, and altered mental state.

Causes and Risk factors

The usual cause of AFLP is thought to be due to a mitochondrial dysfunction in the oxidation of fatty acids leading to an accumulation in hepatocytes. The infiltration of fatty acids causes acute liver insufficiency and this leads to most of the symptoms that present in this condition.

Diagnosis and Treatment

Laboratory tests of AFLP include low blood sugar (hypoglycemia), elevated liver enzymes, and low levels of blood platelets.

AFLP is treated by delivering the baby as soon as possible, often by inducing early labor. Initial treatment involves supportive management with intravenous fluids, intravenous glucose and blood products, including fresh frozen plasma and cryoprecipitate to correct DIC. While laboratory abnormalities may persist after delivery, in rare cases patients may progress to hepatic failure with the need for liver transplantation. Untreated AFLP can cause complete liver failure, bleeding due to impaired blood clotting, and death of the mother and fetus....