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What is Acute Fatty Liver of Pregnancy?

Acute fatty liver of pregnancy, which is characterized by microvesicular fatty infiltration of hepatocytes, is a type of disorder which is a bit unique to human pregnancy. The first and foremost cause of AFLP was thought to be due to a mitochondrial dysfunction in the oxidation of fatty acids leading to an accumulation in hepatocytes. The infiltration of these fatty acids causes acute liver insufficiency, which leads to most of the symptoms that present in this particular condition. If not diagnosed and treated with fastness, AFLP might result in high maternal and neonatal morbidity and mortality.

AFLP also has a detrimental effect on the fetus. One of the complications of AFLP is maternal metabolic acidosis secondary to impaired clearance of serum lactate by damaged hepatocytes. Maternal metabolic acidosis directly affects fetal acid-base status. Therefore, prompt correction of maternal metabolic acidosis is essential to the fetal well-being. Expeditious birth may be necessary.

Often men and women do not know they are a carrier of this changed gene, as their bodies are able to continue to metabolise fatty acids normally. However, when both mother and father carry the gene and both genes are passed on to the baby, the baby is then unable to metabolise some fatty acids and a build-up can occur in the womb.

The un-metabolised free fatty acids return from the baby, via the placenta, to the mother’s blood stream. This can result in hepatic stress for the mother, causing fat infiltrations to build up in the liver.

Who is at risk for acute fatty liver of pregnancy?

Following are the people at risk: 

Having your first pregnancy

Pregnant with twins or more

Pregnant with a boy

Thin body

What are the symptoms associated with acute fatty liver of pregnancy?

AFLP usually starts late in the third trimester of pregnancy. These are the most common symptoms of AFLP:

Nausea and vomiting

Belly pain, especially in the top right side

Feeling unwell (malaise)

Headache

Tiredness

Confusion

Yellowing of skin, eyes, and mucous membranes (jaundice)

If you are pregnant and experiencing any of these symptoms you should make an urgent appointment to see your midwife or GP. If your symptoms are severe or begin to get worse, you should go straight to the hospital. Acute fatty liver of pregnancy is a very serious condition that can cause rapid liver and kidney failure and can be life-threatening for both mother and baby if not diagnosed.

How is acute fatty liver of pregnancy treated?

Once AFLP is diagnosed, the baby will be delivered as quickly as possible. This can help lower the risks to the infected person and their baby. They may need to be in intensive care for several days after delivery. In most cases, the liver function returns to normal within a few weeks.

What are the complications of acute fatty liver of pregnancy?

Both the infected person and their developing baby can become very sick if AFLP is not treated. The person can have liver failure, severe bleeding, kidney failure, and severe infection.

Can acute fatty liver of pregnancy be prevented?

Acute fatty liver of pregnancy is a serious condition that can’t be prevented or predicted.

Treatment for AFLP:

Acute fatty liver of pregnancy is best treated in a centre with expertise in hepatology, high-risk obstetrics, maternal-fetal medicine and neonatology. The physicians who treat this condition will often consult with experts in liver transplantation in severe cases. Admission to the intensive care unit is recommended.

Initial treatment involves supportive management with intravenous fluids, intravenous glucose and blood products, including fresh frozen plasma and cryoprecipitate to correct DIC. The foetus should be monitored with cardiotocography. After the mother is stabilized, arrangements are usually made for delivery. This may occur vaginally, but, in cases of severe bleeding or compromise of the mother's status, a caesarian section may be needed. Often AFLP is not diagnosed until the mother and baby are in trouble, so it is most likely that an emergency C-section is needed.

The complications of acute fatty liver of pregnancy may require treatment after delivery, especially if pancreatitis occurs. Liver transplantation is rarely required for treatment of the condition but may be needed for mothers with severe DIC, those with rupture of the liver, or those with severe encephalopathy.

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