Acute Fatty Liver of Pregnancy: Rare, but Potentially Fatal

Gaspar, Andreia de Vasconcelos; Ascensão, Tânia; Silva, Isabel Santos

doi:10.12659/ajcr.921122

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…However, as AFLP is often associated with DIC at onset, a liver biopsy cannot be performed, and a definitive diagnosis is often not possible in practice. Although there is no consensus on the diagnostic criteria for clinical AFLP, the Swansea criteria are often used as diagnostic criteria [ 13 ]. In our case, a liver biopsy was performed after the coagulation abnormalities had improved, and by including the pathology results, this case matched the diagnostic criteria for AFLP.…”

Section: Discussionmentioning

confidence: 99%

Acute Fatty Liver of Pregnancy Complicated With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report

Suzuki,

Higashide,

Tsubata

et al. 2023

Cureus

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Acute fatty liver of pregnancy (AFLP) is a rare complication of pregnancy that may result in fulminant hepatic failure. A 28-year-old woman, at 36 weeks of gestation, presented to a maternal-fetal outpatient clinic with fever and headache. She was prescribed analgesics and was planned for follow-up. Two days later, she was taken back for evaluation by her husband to the previous physician again because of the subacute onset of impaired consciousness. Blood tests showed a marked elevation of liver enzymes and C-reactive protein (CRP), and the patient was transported to a tertiary hospital. A clinical diagnosis of AFLP or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome was made, and an emergency cesarean section was performed. Unconsciousness was prolonged due to mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) for three days. A liver biopsy was performed on postoperative day 11. Liver biopsy results showed large and small droplet fatty deposits, and the diagnosis of AFLP was confirmed. Thereafter, the elevated liver enzymes resolved spontaneously solely by supportive care. The patient presented with symptoms of impaired consciousness due to mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), which led to a visit to a tertiary hospital and early intervention for AFLP. This case suggested that there may be similarities between the two pathologies of AFLP and MERS.

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Section: Discussionmentioning

confidence: 99%

Acute Fatty Liver of Pregnancy Complicated With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report

Suzuki,

Higashide,

Tsubata

et al. 2023

Cureus

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“…It is difficult to distinguish AFLP from HELLP syndrome as they have similar clinical and laboratory features [7] and around 50% of women with AFLP have concomitant preeclampsia and in both disorders prompt delivery of fetus is required. Other differential diagnosis includes HUS, Thrombotic thrombocytopenia TTP, paracetamol toxicity, exacerbation of SLE and preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

“…LFT begin to fall within 1 -2 days of delivery and complete normalization of LFT is expected in majority of women if early treatment is done [7].…”

Section: Discussionmentioning

confidence: 99%

Case Report-Early Detection of Acute Fatty Liver of Pregnancy in Urgent Care Department with Nonspecific Symptoms

Jangalgi¹,

Faheem²,

Irfan³

2022

OJOG

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Acute fatty liver of pregnancy is a rare but serious disorder affecting pregnancy. The rarity of this situation along with nonspecific symptoms makes it difficult to diagnose and thus causes catastrophic events. Biochemical parameters are required to diagnose this condition and differentiate it from other life threatening causes of pregnancy like HELLP syndrome and Preeclampsia. To avoid complications it is imperative to diagnose this condition at the earliest by doing blood test investigation and symptomatic management and delivery. We present a case in our hospital which came to urgent care with nonspecific symptoms and was diagnosed on blood tests and managed promptly and thus averted a catastrophic event.

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“…Long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) is one of the most commonly documented enzymes affected in patients with AFLP. Common risk factors associated with AFLP include, but are not limited to, nulliparity with a male fetus, multiple pregnancies, low body mass index less than 20 kg/m 2 , and preeclampsia [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Improvement is usually observed in 1 to 2 days after delivery [ 4 ]. Maternal mortality rates in patients with AFLP have improved in recent decades, with global mortality now being below 10% [ 6 ]. One in five women have reported having recurrent AFLP, with most cases being mild [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Fatty Liver of Pregnancy

et al. 2021

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Case series Patients: Female, 23-year-old • Female, 41-year-old Final Diagnosis: Acute fatty liver of pregnancy Symptoms: Abdominal pain • altered mental state • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency resulting from microvesicular infiltration of the liver by fat, leading to liver failure. It usually presents at 36 weeks of gestation, and risk factors include twin pregnancy and low BMI. The presentation of AFLP is nonspecific, requiring a high index of suspicion. The Swansea Criteria is used to aid diagnosis. Case Reports: Case 1: A 23-year-old woman, G1P0 at 39 weeks of gestation, presented to the hospital with a 1-week history of fever, nausea, vomiting, and diarrhea. Examination revealed a gravid uterus with generalized abdominal tenderness. Laboratory investigations revealed elevated liver enzymes, with elevated total bilirubin and an INR of 1.26. CBC showed leukocytosis. Abdominal ultrasound was normal. Workup for other etiologies, including acetaminophen and salicylate overdose and infections, was negative. The Swansea score for AFLP was 8, confirming the AFLP diagnosis. An emergency Cesarean-section was performed, causing liver enzymes to improve over 3 days. Case 2: A 41-year-old woman, G1P1 with a twin gestation at 36 weeks, presented with a 3-day history of abdominal pain. She was jaundiced, with right upper quadrant tenderness. Laboratory investigations showed elevated liver enzymes and total bilirubin, with an INR of 1.26. Workup for viral hepatitis and autoimmune etiology was negative. Salicylate levels were within normal limits. She met criteria for AFLP and underwent emergency Cesarean-section. Liver enzymes improved over 4 days. Conclusions: AFLP is a potentially life-threatening medical condition. From our experience, prompt diagnosis and early delivery leads to improved maternal and fetal outcomes.

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Acute Fatty Liver of Pregnancy: Rare, but Potentially Fatal

Cited by 6 publications

References 14 publications

Acute Fatty Liver of Pregnancy Complicated With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report

Acute Fatty Liver of Pregnancy Complicated With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report

Case Report-Early Detection of Acute Fatty Liver of Pregnancy in Urgent Care Department with Nonspecific Symptoms

Acute Fatty Liver of Pregnancy

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