• Acute Fatty Liver of Pregnancy

    (AFLP)

    Definition

    Acute fatty liver of pregnancy (AFLP) is a rare complication of pregnancy that involves the buildup of fat in the liver. Without prompt treatment, AFLP can lead to coma, organ failure, and death of the mother and baby.
    The Liver
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    Causes

    The cause of AFLP is not known. It may be due to a defect in a specific enzyme in the mother.

    Risk Factors

    Factors that may increase a pregnant woman’s risk of AFLP include:
    • Having a multiples pregnancy—a twin, triplet, or higher order pregnancy
    • First pregnancy
    • Deficiency in the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) enzyme

    Symptoms

    Symptoms are usually not specific. Most symptoms begin in the third trimester and may include:
    • Nausea and vomiting
    • Lack of appetite
    • Abdominal pain
    • Headache
    • Fatigue
    • Yellowing of the whites of the eyes and skin
    • Excessive thirst
    • Increased urination

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.
    Your bodily fluids may be tested. This can be done with:
    • Blood tests to check liver function
    • Urine tests to look for signs of kidney damage
    Images may be taken to check the size of your liver. This can be done with:
    A genetic test may be done after delivery of the newborn. This will determine whether the newborn has LCHAD deficiency. LCHAD deficiency prevents the baby from converting certain fats to energy. This can result in feeding difficulties, low blood sugar, and liver problems.

    Treatment

    Treatment will depend on the severity of your condition but in general includes stabilizing the mother until the baby can be safely delivered.

    Hospitalization and Supportive Care

    After diagnosis, the mother’s and baby’s vital signs will be monitored. This often requires hospitalization. The following treatments may be needed to help stabilize the mother:
    • Treating high blood pressure
    • Treatment low blood sugar
    • IV fluids
    • Supporting airway if needed
    • Blood transfusion—to help support liver function

    Delivery of the Fetus

    The liver will often return to normal function after birth. This may require delivering the baby earlier than expected. Once it is safe for the baby, labor may be started by your doctor. A cesarean section may also be done in severe cases.
    It will take a few days to recover from AFLP after the baby is delivered. The mother and baby will be monitored in the hospital until liver values are improved.

    Prevention

    There is no known way to prevent this condition as the cause is unknown. If you have LCHAD deficiency, you are at increased risk for AFLP in the future.

    RESOURCES

    American Congress of Obstetricians and Gynaecologists http://www.acog.org

    March of Dimes http://www.marchofdimes.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynecologists of Canada http://sogc.org

    References

    Acute fatty liver of pregnancy. British Liver Trust website. Available at: http://www.britishlivertrust.org.uk/liver-information/liver-conditions/acute-fatty-liver-of-pregnancy. Updated August 2012. Accessed August 1, 2016.

    Acute fatty liver of pregnancy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115528/Acute-fatty-liver-of-pregnancy. Updated August 22, 2014. Accessed February 10, 2017.

    Acute fatty liver of pregnancy. Stanford Children’s Health website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=acute-fatty-liver-of-pregnancy-90-P02465. Accessed August 1, 2016.

    Ko H, BSc Pharm MD, et al. Acute fatty liver of pregnancy. Can J Gastroenterol. 2006 Jan;20(1):25-30.

    Liver disorders. March of Dimes website. Available at: http://www.marchofdimes.org/complications/liver-disorders.aspx. Updated February 2009. Accessed August 1, 2016.

    Wakim-Fleming, J. Liver Disease in Pregnancy. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/liver-disease-in-pregnancy. Published August 2010. Accessed August 1, 2016.

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