Diagnosis of early acute fatty liver of pregnancy

Abstract

Acute fatty liver of pregnancy (AFLP) is usually diagnosed at autopsy, with severe hepatic failure, or after the appearance of extrahepatic disease. We present an atypical patient with mild AFLP in whom hepatic biopsy allowed earlier diagnosis. A low threshold for liver biopsy in patients not experiencing fulminant disease can afford diagnostic information prior to the onset of serious sequelae. © 1996 Wiley‐Liss, Inc.

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

“…AFLP is a serious obstetrical emergency that was described in older literature as “rare but often fatal,” owing to its high association with maternal and fetal loss. Before the 1980s, the limited information on AFLP was mainly derived from autopsies done on cases with fulminant liver and multiorgan failures that invariably ended with maternal mortality 11 . During that epoch, related maternal and fetal mortality were 75% and 85%, respectively 8 .…”

Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

“…Research on pregnancy outcomes in women undergoing liver biopsy has largely been limited to case reports, often published many years ago, with some reporting adverse pregnancy outcomes. Further, much of the previous data from liver biopsies in pregnancy come from cases with AFLP because liver biopsy findings are one of the features of the Swansea criteria for AFLP, although seldom performed.…”

“…Although the guidelines of the American Association for the Study of Liver Diseases do not specifically comment on liver biopsy during pregnancy, recent guidelines by the American College of Gastroenterology recommend that pregnant women with abnormal liver tests “should undergo standard workup as with any non‐pregnant individual (strong recommendation, very low level of evidence).” Despite this clear statement, there are few data on the safety of percutaneous liver biopsy during pregnancy. A PubMed search on February 28, 2017, yielded 269 hits for “liver biopsy AND pregnancy,” including only nine women undergoing biopsy during pregnancy, out of which one pregnancy ended with stillbirth and at least two with preterm birth . In addition, we have identified older reports of liver biopsy during pregnancy but without a systematic analysis of pregnancy outcome and no attempt to calculate relative risks (RRs) for adverse pregnancy outcomes associated with liver biopsy.…”