Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases

We describe our experience with the clinical diagnosis, management and, course of patients with acute fatty liver of pregnancy (AFLP).

During the period between January 1996 and June 2010, medical records of patients with AFLP were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes. Routine laboratory evaluation included serial measurement of liver function tests, complete blood cell counts, coagulation profile, and renal function tests.

During the study period 35 women had AFLP as the discharge diagnosis. The mean gestational age at delivery was 36 weeks, 39% were nulliparous and 4 had multiple gestation. The most common presenting symptom was nausea/vomiting (88.5%), jaundice (71.4%), and abdominal pain (51.4%). Maternal morbidity included hypoglycemia (94.2%), renal failure (94.2%), coagulopathy (77.1%), ascites (48.5%), and encephalopathy (40%). There were four maternal deaths (11.4%) and five perinatal deaths (12.5%).

We found a typical 'AFLP-Triad' in women with AFLP. First (symptoms): nausea/vomiting, jaundice, epigastric pain; second (laboratory): results indicated renal dysfunction, coagulopathy, liver function abnormalities, low glycemia, and third (complications): renal failure, coagulopathy, ascites, and encephalopathy. We recommended that patients with this triad received evaluation to rule out the diagnosis of AFLP.