acute fatty liver of pregnancy

3.  Acute fatty liver of pregnancy (AFLP), or reversible
peripartum liver failure, occurs in up to 1 per 7,000
pregnancies and is more common in twin gestations.
 characterized by microvesicular fatty infiltration of the
liver (and possibly kidney) believed to be due to
defective beta oxidation of fat, usually in the third
trimester.
 in 30% to 80% of pregnancies in which the fetus was
found to have a long-chain 3-hydroxyacyl-coenzyme A
dehydrogenase (LCHAD) deficiency.

4.  Incidence <0.01 %
 Presentation 3rd trimester
 Symptoms, Signs & Complications
- Nausea
- Vomiting
- Abdominal pain
- Jaundice
- Hepatic failure
 AFLP is a medical emergency that demands rapid
evaluation and treatment.
 Hepatic failure and fetal death may occur within days.

5.  Laboratory findings are
- Low platelet count
- Hypoglycemia
- Mild to moderate elevation in aminotransferase levels
 Treatment
Management includes control of hypertension, seizure
prophylaxis, and immediate delivery of the fetus or
termination of the pregnancy. Mode of delivery is not as
critical as is doing so expeditiously. Liver transplantation
may be indicated in severe cases
 Outcome
Maternal Death Rate < 12%
Fetal Death Rate < 66%

6.  Neuraxial Anesthesia can worsen the situation.
 General Anesthesia is preferable.
 The anesthesiologist should anticipate postpartum
hemorrhage, establish adequate intravenous access,
and ensure that cross matched blood is immediately
available for any parturient with AFLP. There is often a
worsening of liver function, renal function, and
coagulopathy for 48 hours after delivery, followed by
improvement during the subsequent weeks.