|Obstetric definitions
|Diabetes and Pregnancy
|Caesarean Section (CS)
|Epilepsy in Pregnancy
|Resuscitation - Obstetric Cardiac Arrest
|Normal Labour
|Premature Labour
|Ectopic Pregnancy
|Acute Fatty Liver of Pregnancy
|Multiple Pregnancy
|Prescribing in Pregnancy
|Termination of Pregnancy (Abortion)
|VTE DVT PE in Pregnancy
AFLP is a rare, life-threatening complication of pregnancy with variable presentation and rapid unpredictable complications usually occurs in late pregnancy.
About
- AFLP is an obstetric emergency
- Acute fatty liver of pregnancy (AFLP) first described 1940
- Acute liver/renal failure seen end of pregnancy or post-partum
- Seen in 1 in 15,000 pregnancies with high mortality
Aetiology
- Seen in third trimester of pregnancy or post-partum
- Acute liver failure with associated buildup of liver fat
- LCHAD: Long-chain hydroxy acyl-CoA dehydrogenase in the fetus
Risks
- Primigravida
- Twin pregnancy
- male fetus
Clinical
- Nausea and vomiting, loss of appetite
- Epigastric pain
- Jaundice, Encephalopathy, malaise
Investigations
- FBC: Normal platelet count unless severe and DIC
- Coagulopathy: prolonged PT, low fibrinogen (usually high in pregnancy)
- LFTs: High AST and ALT, usually <1,000
- Elevated bilirubin, Hyperammonemia, hypoglycaemia
- R/O associated defect in beta oxidation of fatty acids, DNA testing
available for the most common defect associated with acute fatty
liver of pregnancy, long chain 3-hydroxyl-acyl CoA dehydrogenase.
Test patient, her baby and baby's father
- USS: fatty liver and ascites
- Viral studies - exclude viral hepatitis and leptospirosis
Pathology
- Central pallor with microvesicular fat on special stains
- Hepatocytes may mimic viral hepatitis
- There is no inflammation or necrosis
Differentials
- HELLP syndrome (low plts)
- Viral hepatitis
- Drug induced fulminant hepatic failure
Complications
- Post partum haemorrhage with DIC and coagulopathy
- Acute hepatic failure, with ascites
- Renal failure, GI bleeding, prolonged jaundice
- Nephrogenic diabetes insipidus may occur
Management
- ABC, resuscitation. Obstetric consultation, consider prompt delivery and manage post-partum haemorrhage and referral to liver unit.
- Broad spectrum antibiotics for infection. Manage coagulopathy and encephalopathy
- May require ICU, dialysis. Liver transplantation not indicated except very rarely
References