Acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) is a rare obstetric complication that usually occurs during the third trimester of pregnancy or in the early postpartum period. This is characterised by maternal liver dysfunction and fetal complications that lead to death.
- Prior history of acute fatty liver of pregnancy
- Low body mass index
- Fetal male sex
- Multiple gestations
Pathogenesis of AFLP
AFLP is considered to develop due to the defects in the metabolism of fatty acids. Normally, an increased amount of free fatty acids are produced during pregnancy. But if there is a defect in this metabolism, it leads to liver dysfunction.
- AFLP is usually noticed between 30-38 weeks of gestational age.
- Specific symptoms during the initial stage include nausea, vomiting, fatigue, loss of appetite, and abdominal pain.
- If the condition worsens, the patient will develop features of liver failure such as jaundice, altered mental status, ascites, bleeding tendency, and multiorgan failure.
Blood tests are done to note bilirubin levels, serum ammonia levels, liver enzymes, renal parameters, and low platelets.
Ultrasound imaging of the abdomen shows non-specific fatty liver changes.
Also Read: Success of Liver Transplantation, post-transplant Dos and Don’ts
Management of AFLP
The patients are recommended to be managed in a tertiary care centre with facilities for a liver transplant. Liver transplantation in India has become common, and the success rate has increased greatly. AFLP patients will require a multidisciplinary team approach involving obstetricians, hepatologists, neonatologists, liver transplant surgeons, and critical care physicians.
The goal of AFLP management involves the treatment of hypoglycemia, coagulopathy, and encephalopathy. Fetal monitoring should be done, and prompt delivery should be planned as soon as the diagnosis is made.
In Kauvery Hospital, we have the best liver transplant surgeons and a multidisciplinary team that could effectively manage AFLP. If you notice any of these symptoms during pregnancy, make sure to consult the doctor immediately.
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