[Acute fatty liver in pregnancy: a clinicopathologic study]

To investigate the early recognition and management of milder cases of acute fatty liver in pregnancy (AFLP).

Twelve cases of AFLP treated in our hospital during the past two and half years were retrospectively studied with emphasis on symptoms, laboratory findings, liver biopsy and maternal complications. The 12 cases were classified into 2 groups. Group 1, 6 cases of advanced AFLP diagnosed clinically, were treated in the first year of the study. Group 2, 6 cases of milder AFLP diagnosed by postpartum liver biopsy, were treated during the last one and half years of the study.

The mean gestational age at onset was 34 +/- 3 weeks. In the early stage, all cases had malaise, nausea, loss of appetite and epigastric distress followed by jaundice in the third trimester of pregnancy. Laboratory findings included raised transaminases (< or = 300 IU/L) and total serum bilirubin (32.5-510.8 micro mol/L) levels, hypoalbuminemia (18-30 g/L), hypofibrogenemia (< 2.4 g/L), prolonged prothrombin time and prolonged partial thromboplastin time. Maternal complications were frequent including hepatic encephalopathy (9), ascites (9), hypoglycemia (7), renal failure (3), hematemesis (4), preeclampsia (6), and postpartum hemorrhage (5). Cesarean sections were performed in 7 cases. In group 2, both mother and fetuses had 100% survival. However, the mortality of the mothers and fetuses in group 1 were both 50%.

With increasing awareness, especially in the early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved. Percutaneous liver biopsy should be done when the coagulation tests became normal and the amounts of ascites decreased after delivery.