Prospective study of acute fatty liver of pregnancy in South Wales

Abstract

We conducted a prospective study of acute fatty liver of pregnancy (AFLP) in a defined population in South Wales, UK. All pregnancies between March 1999 and June 2001 in an obstetric unit serving 270 000 were screened for AFLP, diagnosis based on symptoms, biochemistry and haematology, histology when appropriate and exclusion of other hepatobiliary diseases. Nine AFLP patients were identified among 8142 pregnancies—incidence 1 in 900. Age range 18–36 years. One twin pregnancy, four had had 1 or 2 previous pregnancies, two complicated by miscarriages. All were symptomatic: vomiting 8, abdominal pain 7 and polyuria/polydipsia 5. One had hyperemesis gravidarum and one pre-eclampsia. Symptoms started between 33 and 38 weeks. All had elevated AST (80–542; median 153 U/l), bilirubin raised in seven (19–246; median 52 µmol/l), γGT raised in five (58–229; median 60 U/l). Leucocytosis and hyperuricaemia in all, renal impairment in five, coagulopathy in three, hyperammonaemia in two and hypoglycaemia in one. Liver biopsy from three patients (post-partum) showed typical microvesicular fatty change. Induction or caesarean section was undertaken in all because of AFLP. No maternal or fetal death but three babies required admission to SCBU. Symptoms and abnormal liver function resolve within 10 weeks after delivery.