[Acute fatty liver in pregnancy. Current concepts]

Area of Science:

• Hepatology
• Obstetrics
• Maternal-Fetal Medicine

Context:

• Acute fatty liver of pregnancy (AFLP) is a serious obstetric complication.
• Typically occurs in the third trimester (32-36 weeks gestation).
• Etiology remains largely unknown.

Purpose:

• To summarize the clinical presentation, diagnostic considerations, and management of AFLP.
• To highlight recent improvements in maternal outcomes.
• To review fetal prognosis and identify key factors for better results.

Summary:

• APLF presents with non-specific symptoms like nausea, vomiting, jaundice, and abdominal pain.
• Laboratory findings include elevated liver enzymes, bilirubin, and ammonia, with decreased platelets and coagulation factors.
• Diagnostic imaging is primarily for excluding other conditions; hepatic biopsy is reserved for atypical cases.

Impact:

• Maternal mortality has significantly decreased due to advances in care.
• Fetal prognosis has improved, but a 20% mortality rate persists.
• Early diagnosis, timely pregnancy termination, and specialized care are crucial for optimal materno-fetal outcomes.