Abstract
Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death.
Highlights
Acute fatty liver of pregnancy (AFLP) is a rare and potentially life-threatening complication which tends to manifest in the third trimester of pregnancy/early postpartum period
The aim of the present study is to explore the clinical outcome of patients with AFLP, evaluate the effect of early diagnosis and treatment, and analyze the influence of the mode of delivery on
Summarizing the data from 126 cases, AFLP should be highly suspected when the following clinical conditions occur: first (i) gastrointestinal symptoms, which include nausea, vomiting, vague abdominal pain, polydipsia/polyuria, and persistent jaundice appearing in late pregnancy without obvious reason; second (ii) abnormal liver function occurring in late pregnancy, when other hepatic diseases have been excluded; laboratory examination showing elevated leukocytes, total bilirubin, especially direct bilirubin, prothrombin time, hepatic aminotransferase levels (ALT, AST), and decreased platelets; and third (iii) pregnancy complicated rapidly with renal insufficiency, hepatic inadequacy, coagulopathy, hypoglycemia, Symptoms Vomiting Epigastric pain Jaundice Polydipsia Pruritis Encephalopathy
Summary
Acute fatty liver of pregnancy (AFLP) is a rare and potentially life-threatening complication which tends to manifest in the third trimester of pregnancy/early postpartum period. Maternal mortality is estimated to be 12.5%–18%, with a neonatal mortality rate of 7%–66% [1]. A prospective UK-based research study, involving 229 centers identified 57 confirmed cases in a total of 1,132,964 pregnancies, giving an incidence of 5 in 100,000 pregnancies [3]. It is important to further lower the mortality rate by early diagnosis and prompt treatment of this disease. Some cases of AFLP have been analyzed retrospectively for improvement of comprehensive knowledge. The aim of the present study is to explore the clinical outcome of patients with AFLP, evaluate the effect of early diagnosis and treatment, and analyze the influence of the mode of delivery on
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