Acute fatty liver of pregnancy

AFLP is a syndrome that occurs in the last trimester or postpartum, characterized by jaundice, coagulopathy, and central nervous system disturbances. Renal insufficiency is common. Clinical and laboratory findings are nonspecific. Diagnosis is based primarily on histologic examination of the liver. The cause of AFLP is unknown. The illness has been associated with a high maternal and fetal mortality; with increased awareness and more liberal use of liver biopsy, however, milder forms of the disease are now recognized. Some speculate that AFLP is part of the spectrum of preeclampsia. Liver histology shows microvesicular fat and little or no inflammation or hepatocellular necrosis. Treatment consists of expeditious delivery and maximal supportive care, which may include intensive care unit monitoring, blood component therapy, glucose infusion, sodium restriction, diuretic agents, mechanical ventilation, and dialysis. The role of hepatic transplantation in AFLP appears limited. The risk of mortality during AFLP must be compared with the short- and long-term morbidity and mortality associated with liver transplantation.