Acute fatty liver of pregnancy: diagnosis and management of 8 cases.

OBJECTIVE

To investigate the early recognition and management of acute fatty liver of pregnancy (AFLP) to improve maternal and fetal survival.

METHODS

Eight cases of AFLP seen in our hospital during the past three years were studied retrospectively. Symptoms, laboratory findings, timing of liver biopsy, and maternal and fetus outcome were assessed.

RESULTS

The mean gestational age at onset was 34 +/- 2 weeks. All cases were primigravida. In the early stages, all patients presented malaise, nausea, vomiting and epigastric distress followed by jaundice in the third trimester of pregnancy.

LABORATORY FINDINGS

all had raised transaminases and serum bilirubin (32.5-510.8 mumol/L), hypoalbuminemia (22.4-30.0 g/L), hypofibrinogenemia (< 180 mg/dl), prolonged prothrombin time and prolonged partial thromboplastin time. Maternal complication included hepatic encephalopathy (6 cases), ascites (6), hypoglycemia (5), hematemesis (2), and postpartum hemorrhage (5) and preeclampsia (4). Emergency cesarean section was performed in 3 cases. One mother died of fulminant hepatic failure and the others survived. There was no fetus death. Liver biopsy was done on the 5th to 15th postpartum day in 8 cases.

CONCLUSION

With increasing awareness, especially in the early recognition of milder cases, and prompt progressive management including early termination of pregnancy by cesarean section and large dose infusion of fresh frozen plasma and albumin alternately, the prognosis of AFLP can be improved.