Acute Fatty Liver of Pregnancy

Acute Fatty Liver of Pregnancy Acute fatty liver of pregnancy is a rare condition (1 in 20,000 pregnancies), characterised by liver failure of varying degrees due to microvacuolar fatty transformation of hepatocytes. It is identified by the U.K. Confidential Enquiry into Maternal Deaths as a leading cause of maternal mortality. It usually presents in the third trimester of pregnancy with abdominal pain, vomiting and weakness. These symptoms are present in 60% to 80% of cases (75,76). Symptoms can progress as a result of abnormal coagulation [prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT), low fibrinogen] and liver and renal failure to confusion and seizures secondary to encephalopathy and hypoglycaemia. In the acute phase the condition has clinical and diagnostic features similar to HELLP syndrome and management may be similar. When the exact diagnosis remains unclear in the acute phase the treatment for both is similar and the two conditions have been grouped together as ‘acute hepatic dysfunction of pregnancy’ (AHDOP). As with HELLP syndrome management relies on early diagnosis, prompt delivery, correction of coagulopathy and intensive supportive care. Liver biopsy is seldom performed to confirm the diagnosis because of the risk of bleeding secondary to coagulopathy. Recent studies report a maternal mortality around 13% and a fetal mortality around 17% (77-79). A recent U.K. survey studied outcomes in 61 cases and reported no maternal mortality and a 13% fetal mortality (80).