Acute Fatty Liver of Pregnancy: A Clinical-Paraclinical Survey

Abstract

Background: Acute Fatty Liver of Pregnancy (AFLP) is one of the serious complications of the pregnancy period. Surveying the laboratory and clinical signs is effective in timely prognosis and fast treatment of this illness. Objectives: The current study aimed to evaluate AFLP among the hospitalized subjects. Patients and Methods: This retrospective study was conducted on clinical and preclinical records of 25 females with AFLP for maternal and perinatal prognosis from 2000 to 2009. The data was analyzed using SPSS ver. 19. Results: The patients aged 16-45 years old with one to four pregnancies; they were 24 to 39 weeks pregnant with the mean of 33.56 weeks, and 56% were multifarious. The most prevalent clinical symptoms were nausea, vomiting, abdominal pain, headache, pruritus, and icterus. The laboratory signs included disorders of liver, coagulation, kidney, and hypoglycemia. Nausea and vomiting in the first and second age groups (Group 1, patients were < 25 years; Group 2, patients were 25-35 years) and abdominal pain (100%) in the third group (Group 3, patients were > 35 years.) were the most prevalent symptoms. No patient had fever, ascites, and polydipsia. There was one case of mother and fetal death. Conclusions: In the current study, the clinical and paraclinical signs of AFLP were mostly-liver, coagulation, kidney, and hypoglycemia disorders. Considering that patients mostly refer in three phases of clinical, laboratory, and complications, it is essential to evaluate the suspected ones who present clinical symptoms especially nausea, vomiting and abdominal pain.

Acute Fatty Liver of Pregnancy: A Life-Threatening Condition Requiring a Life-Saving Approach

“…As the first step, liver and coagulation function tests could be performed for any pregnant woman who complains of new-onset gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. If abnormal results are found, further tests should be performed, including renal function tests, blood glucose level, and abdominal ultrasound ( 5 , 11 - 13 ).…”

“…Unlike HELLP syndrome and severe preeclampsia, which are the other potentially fatal disorders unique to the last trimester of pregnancy and puerperium, AFLP is a true hepatic dysfunction. Hence, impaired coagulation function tests should be more prominent as they could have prognostic value ( 5 , 13 , 14 ). In a study by Meng et al involving 43 patients managed in a tertiary care center, the levels of prothrombin time, plasma fibrinogen, and platelet counts were correlated with the recovery time, while the leukocyte count, serum blood glucose, and hepatic aminotransferase levels showed no value in predicting the prognosis ( 14 ).…”

“…In sum, it is important to note that the management of AFLP is a multidisciplinary progress that necessitates active and prompt intervention by gastroenterologists and anesthesiologists along with obstetricians and neonatologists in a tertiary care center equipped with an intensive care unit ( 9 , 13 , 18 ). While as deleterious as both preeclampsia and HELLP syndrome, AFLP differs in that its management requires more than just the termination of the pregnancy.…”