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Pan X, Chu R, Qiao X, Zhang X, Li L, Zhang W. Association of Adverse Perinatal Outcomes with Blood Components Transfusion in Patients with Acute Fatty Liver of Pregnancy. Int J Womens Health 2025; 17:21-32. [PMID: 39802922 PMCID: PMC11720634 DOI: 10.2147/ijwh.s477944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025] Open
Abstract
Purpose To investigate the rare obstetric emergency with no specific treatments called acute fatty liver of pregnancy. The primary objective was to evaluate association of adverse perinatal outcomes with blood components transfusion. While the secondary objective focused on further establishing the predictive risk factors for adverse perinatal outcomes. Participants and Methods This retrospective cohort study included patients, who diagnosed with acute fatty liver of pregnancy without hepatic/malignant diseases in Qilu Hospital of Shandong University over 12-year period (collected 2007-2019, aged 20-41years). Chi-square test was used to explore the relevance between blood transfusion therapy and adverse perinatal outcomes. Meanwhile, logistic regression analysis was performed to identify predictive risk factors. Results Of 146 patients, 26 (26/146, 17.8%) received prenatal blood transfusions. These patients had reduced gestational ages and exhibited more severe clinical symptoms. The association between blood transfusion and adverse maternal outcomes yielded a P value of 0.044, while the association with fetal outcomes was highly significant (P<0.001). Multivariate logistic regression analysis identified seven high-risk factors for maternal outcomes and six for fetal outcomes, all demonstrating strong discriminatory capacity. Conclusion Blood component transfusion may serve as a marker of disease severity. Prompt identification of patients with high-risk factors is crucial to improve maternal and fetal outcomes.
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Affiliation(s)
- Xiyu Pan
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, People’s Republic of China
| | - Xu Qiao
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Xianru Zhang
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Li Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Wenxia Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China
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2
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Karnsakul W, Schwarz KB. Hepatitis. REMINGTON AND KLEIN'S INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2025:728-744.e4. [DOI: 10.1016/b978-0-323-79525-8.00036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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3
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Alexander V, Benjamin SJ, Subramani K, Sathyendra S, Goel A. Acute liver failure in pregnancy. Indian J Gastroenterol 2024; 43:325-337. [PMID: 38691240 DOI: 10.1007/s12664-024-01571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/09/2024] [Indexed: 05/03/2024]
Abstract
Liver function abnormalities are noted in a minority of pregnancies with multiple causes for the same. A small proportion of these develop severe liver injury and progress to acute liver failure (ALF). There is a discrete set of etiology for ALF in pregnancy and comprehensive understanding will help in urgent evaluation. Certain diseases such as acute fatty liver of pregnancy, hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome and pre-eclampsia are secondary to pregnant state and can present as ALF. Quick and targeted evaluation with urgent institution of etiology-specific management, especially urgent delivery in patients with pregnancy-associated liver diseases, is the key to avoiding maternal deaths. Pregnancy, as also the fetal life, imparts a further layer of complication in assessment, prognosis and management of these sick patients with ALF. Optimal management often requires a multidisciplinary approach in a well-equipped centre. In this review, we discuss evaluation, assessment and management of pregnant patients with ALF, focussing on approach to pregnancy-associated liver diseases.
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Affiliation(s)
- Vijay Alexander
- Department of Hepatology, Christian Medical College, Vellore 632 004, India
| | - Santosh J Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore 632 004, India
| | - Kandasamy Subramani
- Division of Critical Care, Christian Medical College, Vellore 632 004, India
| | - Sowmya Sathyendra
- Department of Obstetric Medicine, Christian Medical College, Vellore 632 004, India
| | - Ashish Goel
- Department of Hepatology, Christian Medical College, Vellore 632 004, India.
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4
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White M, Han H, Khungar V. Acute fatty liver disease of pregnancy. Clin Liver Dis (Hoboken) 2024; 23:e0145. [PMID: 38487350 PMCID: PMC10939648 DOI: 10.1097/cld.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/07/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Mary White
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Hannah Han
- Yale University, New Haven, Connecticut, USA
| | - Vandana Khungar
- Department of Internal Medicine, Section of Digestive Diseases, Yale New Haven Hospital, New Haven, Connecticut, USA
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Brügge M, Pecks U, Iannaccone A, Palz-Fleige M, Stepan H, Tauscher A. [Acute Fatty Liver of Pregnancy - Case Series]. Z Geburtshilfe Neonatol 2023; 227:466-473. [PMID: 37490932 DOI: 10.1055/a-2096-6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
With a prevalence of 0,01-0,03%, acute fatty liver in pregnancy (AFLP) is a rare and dangerous complication of pregnancy and is difficult to distinguish from other, sometimes more common, pregnancy diseases such as HELLP syndrome, aHUS and TTP because of its mostly non-specific symptoms. Due to its rarity, AFLP is often not obvious to the obstetrician as a possible differential diagnosis. Yet early diagnosis and the fastest possible delivery is the only causal therapy and is important for the mortality rate. In the present manuscript, the pathophysiology, diagnosis and therapy of acute fatty liver in pregnancy are highlighted for the clinical routine based on case descriptions from three university hospitals, and reference is made to possible findings that are helpful in establishing the diagnosis. The angiogenic preeclampsia marker sFlt-1 plays a role and provides new opportunities to consider pathophysiological approaches.
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Affiliation(s)
- Martina Brügge
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
| | - Monika Palz-Fleige
- Klinik für Gynäkologie und Geburtshilfe, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Holger Stepan
- Geburtsmedizin, Universitätsfrauenklinik Leipzig, Leipzig, Germany
| | - Anne Tauscher
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
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6
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Sinha S, Yadav J, Pradhan T. A Case Report on Acute Fatty Liver of Pregnancy: A Difficult Differential Diagnosis of Liver Disorder. Cureus 2023; 15:e42733. [PMID: 37654930 PMCID: PMC10467326 DOI: 10.7759/cureus.42733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/02/2023] Open
Abstract
Acute fatty liver of pregnancy is a rare but potentially dangerous pregnancy condition with significant maternal and fetal fatality rates. The disorder is driven by a complex pathophysiology and clinically manifests as a rapid worsening in health conditions, increasing the rate of mortality and necessitating expert diagnosis and management. The condition progresses from spontaneous resolution to post-operative complications, resulting in negative consequences. We offer a case report of a young primigravida patient diagnosed with acute fatty liver of pregnancy at term. The report describes the clinical course and its effect. The perinatal result, however, could not be improved due to the late diagnosis. Over the last 40 years, death rates have been dramatically lowered because of competence and a multidisciplinary approach, increasing maternal-fetal outcomes. In this scenario, time management is crucial to success.
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Affiliation(s)
- Shivangni Sinha
- Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, IND
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Jyotsna Yadav
- Obstetrics and Gynecology, BP Koirala Institute of Medical Sciences, Dharan, NPL
| | - Tarun Pradhan
- Obstetrics and Gynecology, Birat Medical College and Teaching Hospital, Dharan, NPL
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7
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Mitochondrial Dysfunction and Acute Fatty Liver of Pregnancy. Int J Mol Sci 2022; 23:ijms23073595. [PMID: 35408956 PMCID: PMC8999031 DOI: 10.3390/ijms23073595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
The liver is one of the richest organs in mitochondria, serving as a hub for key metabolic pathways such as β-oxidation, the tricarboxylic acid (TCA) cycle, ketogenesis, respiratory activity, and adenosine triphosphate (ATP) synthesis, all of which provide metabolic energy for the entire body. Mitochondrial dysfunction has been linked to subcellular organelle dysfunction in liver diseases, particularly fatty liver disease. Acute fatty liver of pregnancy (AFLP) is a life-threatening liver disorder unique to pregnancy, which can result in serious maternal and fetal complications, including death. Pregnant mothers with this disease require early detection, prompt delivery, and supportive maternal care. AFLP was considered a mysterious illness and though its pathogenesis has not been fully elucidated, molecular research over the past two decades has linked AFLP to mitochondrial dysfunction and defects in fetal fatty-acid oxidation (FAO). Due to deficient placental and fetal FAO, harmful 3-hydroxy fatty acid metabolites accumulate in the maternal circulation, causing oxidative stress and microvesicular fatty infiltration of the liver, resulting in AFLP. In this review, we provide an overview of AFLP and mitochondrial FAO followed by discussion of how altered mitochondrial function plays an important role in the pathogenesis of AFLP.
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8
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Liver Biopsy in Pregnancy: Two Case Reports and Review of the Literature. Dig Dis Sci 2021; 66:4090-4098. [PMID: 33433812 DOI: 10.1007/s10620-020-06786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/14/2020] [Indexed: 12/09/2022]
Abstract
The etiology of most cases of liver diseases in pregnancy can be diagnosed with a thorough history, physical examination, laboratory values, serology, and noninvasive imaging. However, atypical clinical and laboratory presentations of liver diseases/chemistries require a liver biopsy to render an accurate diagnosis in cases where the biopsy results affect the timing of delivery or impact choice of medical therapy. According to the American College of Gastroenterology, liver biopsy can be effectively and safely conducted in pregnant women. Conventional routes of performing a liver biopsy include the percutaneous, transjugular route, and surgical methods. Endoscopic ultrasound-guided liver biopsy is a recent technique that has not yet gained widespread adoption but can potentially serve as an alternative route for obtaining the liver sample. Adverse events associated with liver biopsy include abdominal pain and hemorrhage. Maternal and fetal outcomes are limited to increased risk of preterm birth and small for gestational age neonate. However, very few studies have formally evaluated the safety of liver biopsy in pregnant women. In this review, we present two successful cases of liver biopsy performed during pregnancy and summarize the most recent evidence regarding the safety and outcomes of the procedure in pregnancy to assist clinicians in their decision to perform a liver biopsy during pregnancy or postpone it until after delivery.
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9
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Liew-Spilger AE, Sorg NR, Brenner TJ, Langford JH, Berquist M, Mark NM, Moore SH, Mark J, Baumgartner S, Abernathy MP. Viscoelastic Hemostatic Assays for Postpartum Hemorrhage. J Clin Med 2021; 10:3946. [PMID: 34501395 PMCID: PMC8432102 DOI: 10.3390/jcm10173946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.
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Affiliation(s)
- Alyson E. Liew-Spilger
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA;
| | - Nikki R. Sorg
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Toby J. Brenner
- Division of Natural Sciences, Indiana Wesleyan University, Marion, IN 46953, USA;
| | - Jack H. Langford
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | - Margaret Berquist
- College of Science, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Natalie M. Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Spencer H. Moore
- Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA;
| | - Julie Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Sara Baumgartner
- Department of Obstetrics and Gynecology, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Mary P. Abernathy
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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10
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Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis. Case Reports Hepatol 2021; 2021:8820350. [PMID: 33763269 PMCID: PMC7964110 DOI: 10.1155/2021/8820350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare obstetric condition that classically presents in the third trimester or early postpartum period and can lead to liver failure and death. Only six second trimester AFLP cases have been reported in the English literature. We present the earliest case of AFLP at 15 weeks of gestation confounded by a high titer anti-nuclear antibody (ANA >1 : 1280) and concern for autoimmune hepatitis. Our patient had intrauterine fetal demise with prompt dilation and evacuation. Sepsis and multisystem organ failure ensued, and she was transferred to a liver transplant center where she expired without further intervention.
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11
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Aabdi M, Mellagui Y, Ouachaou J, Ounci E, Bkiyar H, Housni B. Plasma exchange as treatment for acute fatty liver disease of pregnancy. Clin Case Rep 2021; 9:1594-1597. [PMID: 33768896 PMCID: PMC7981603 DOI: 10.1002/ccr3.3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022] Open
Abstract
Acute fatty liver disease of pregnancy AFLP is an obstetrical emergency, with severe complications that may include death. Management of AFLP is challenging and include plasma exchange which helps to improve the prognosis for both mother and fetus and delay liver transplantation.
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Affiliation(s)
- Mohammed Aabdi
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Yassine Mellagui
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Jamal Ouachaou
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Essad Ounci
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Houssam Bkiyar
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
| | - Brahim Housni
- Department of Anesthesiology and Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI University HospitalMohammed I UniversityOujdaMorocco
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12
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Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management. Anesthesiology 2020; 130:446-461. [PMID: 30707120 DOI: 10.1097/aln.0000000000002597] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A narrative review of the pathophysiology, diagnosis, management, delivery implications, obstetric anesthesia care, and potential critical care needs in patients presenting with acute fatty liver of pregnancy.
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13
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Utility of MELD scoring system for assessing the prognosis of acute fatty liver of pregnancy. Eur J Obstet Gynecol Reprod Biol 2019; 240:161-166. [DOI: 10.1016/j.ejogrb.2019.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022]
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Abstract
Hepatitis E virus (HEV) infection has distinct features, depending upon the genotype and geographical area. HEV genotypes 1 and 2 are endemic to various developing countries causing epidemics of acute viral hepatitis with human to human transmission. On the other hand, HEV genotypes 3 and 4 prevalent in developed countries commonly lead to subclinical infection and are transmitted zoonotically. HEV infection typically causes acute self-limiting illness associated with low morbidity and mortality. Infection with HEV genotype 1 or 2 in pregnancy, especially in the third trimester may lead to severe illness and fulminant liver failure. Poor maternal and fetal outcomes have been reported. Areas covered: This review highlights the various aspects of HEV infection in pregnancy including diagnosis, management, and prevention. Expert commentary: Treatment is mainly supportive with diligent monitoring and intensive care. Therapeutic termination of pregnancy cannot be recommended based to the available literature. Early liver transplantation (LT) should be considered in these patients although the indications and timing of LT are still controversial. Prevention of HEV infection or illness by improved sanitation and active/passive immunization needs further research.
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Affiliation(s)
- Premashis Kar
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
| | - Anando Sengupta
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
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Ilham Aldika Akbar M, Mayang Sari I, Aditiawarman, Gumilar Dachlan E, Dekker G. Clinical characteristics of acute fatty liver of pregnancy in a tertiary Indonesian hospital. J Matern Fetal Neonatal Med 2017; 32:1-191. [PMID: 29034746 DOI: 10.1080/14767058.2017.1393067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 01/16/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare, often autosomal recessive disorder with a major risk for maternal and perinatal mortality and morbidity. In order to achieve a more favorable outcome, awareness of its clinical signs and symptoms and early recognition are of pivotal importance. Over a 5-year period 18 patients were diagnosed with AFLP (one twin, 19 babies). The most common sign and symptoms were jaundice, hypoglycemia, nausea and vomiting, encephalopathy, and hypertension. Abnormal laboratory test results included: elevated total/ conjugated (direct) bilirubin, AST, ALT, PT, APTT, creatinine, leukocyte count, and hypoalbuminemia. Maternal and fetal mortality rate was high: 66.7% resulted in a maternal death and 57.9% in an intrauterine fetal demise (IUFD). The number of complications was found to correlate with maternal death (p = 0.042). Surviving AFLP patients had ≤ 3 complications, while patients with > 3 complications on presentation had a high risk of maternal death (OR = 5.0; 95% CI: 0.55-45.4). The presence of hypertension significantly increased the risk of maternal death (OR: 24.5; 95% CI: 1.1-542.8; p = 0.01). The risk of IUFD was primarily related to gestational age at delivery and birth weight. The high rate of jaundice as presenting symptom of AFLP suggests that Indonesian primary maternity care providers may often miss its important earlier signs and symptoms, in particular de-novo onset of nausea and vomiting in late pregnancy.
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Affiliation(s)
| | - Indah Mayang Sari
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Aditiawarman
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Erry Gumilar Dachlan
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Gustaaf Dekker
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
- b Department Obstetrics & Gynaecology , Lyell Mc Ewin Hospital , the University of Adelaide , Adelaide , Australia
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Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management. Am J Gastroenterol 2017; 112:838-846. [PMID: 28291236 DOI: 10.1038/ajg.2017.54] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/03/2017] [Indexed: 12/11/2022]
Abstract
Acute fatty liver of pregnancy (AFLP) is an obstetric emergency characterized by maternal liver failure and may have complications for the mother and fetus, including death. This review examines recent literature on the epidemiology, pathogenesis, diagnosis, and treatment of acute fatty liver of pregnancy. Pathogenesis of this disease has been linked to defects in fatty acid metabolism during pregnancy, especially in the setting of fetal genetic defects in fatty acid oxidation. The value of screening all patients for these genetic defects remains to be determined. Distinguishing AFLP from other high-risk liver diseases of pregnancy that have overlap features, such as HELLP and preeclampsia, can be challenging. Although sensitive diagnostic tools such as the Swansea criteria have been developed, further work is needed to diagnose AFLP more quickly. Although survival rates have improved in the past 30 years, delay in diagnosis and treatment of AFLP has life-threatening consequences; an algorithmic approach to AFLP may be a valuable resource for clinicians. Future epidemiological and long-term studies will improve our prediction of women at risk for developing AFLP and determine the long-term consequences of this condition.
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17
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Wang S, Li SL, Cao YX, Li YP, Meng JL, Wang XT. Noninvasive Swansea criteria are valuable alternatives for diagnosing acute fatty liver of pregnancy in a Chinese population. J Matern Fetal Neonatal Med 2017; 30:2951-2955. [PMID: 27923319 DOI: 10.1080/14767058.2016.1269316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aims to assess the diagnostic and prognostic value of Swansea criteria in diagnosing acute fatty liver of pregnancy (AFLP) in a Chinese population. METHODS A retrospective study was conducted on 52 Chinese women diagnosed with AFLP. All selected cases were reassessed using the Swansea criteria with special focus on the noninvasive criteria, since performing a liver biopsy for this indication is rare in a Chinese population. RESULTS Ninety point four percent of patients fulfilled five or more of the Swansea criteria. Thirty-one cases were positive for six or more Swansea criteria, but there were no significance differences between patients when using a cutoff criteria <6 or >6. When patients were positive for less than seven criteria, frequency of stillbirth, continuous blood purification (CBP) treatment, hysterectomy, and postpartum hemorrhage were not increased. However, patients who were positive for seven or more criteria had a significantly higher risk of stillbirth and a higher rate of CBP treatment (p < 0.05). Areas under the receiver operating characteristic (ROC) curve of postpartum hemorrhage was 0.670, which reached a statistical significance (p = 0.040). We observed a significantly elevated postpartum hemorrhage along with positivity of the Swansea criteria (p = 0.040). CONCLUSIONS Swansea criteria without liver biopsy are good screening tools for AFLP diagnosis, and may be useful for assessing disease severity.
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Affiliation(s)
- Shan Wang
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Shan-Ling Li
- b Department of Obstetrics and Gynecology , Shandong Provincial Maternity and Childcare Hospital , Jinan , China
| | - Yan-Xia Cao
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Yan-Ping Li
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Jin-Lai Meng
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
| | - Xie-Tong Wang
- a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China
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Meng J, Wang S, Gu Y, Lv H, Jiang J, Wang X. Prenatal predictors in postpartum recovery for acute fatty liver of pregnancy: experiences at a tertiary referral center. Arch Gynecol Obstet 2015; 293:1185-91. [DOI: 10.1007/s00404-015-3941-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 10/23/2015] [Indexed: 12/19/2022]
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Minakami H, Morikawa M, Yamada T, Yamada T, Akaishi R, Nishida R. Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts. J Obstet Gynaecol Res 2014; 40:641-9. [PMID: 24428400 DOI: 10.1111/jog.12282] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 12/17/2022]
Abstract
As proposed criteria (Swansea criteria) for the diagnosis of acute fatty liver of pregnancy (AFLP) do not include antithrombin (AT) activity, diagnosis of AFLP may be delayed. The aim of this review is to underscore problems in the differential diagnosis of AFLP and the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) and to facilitate prompt diagnosis of AFLP. Published works dealing with liver dysfunction in pregnancy, HELLP syndrome and AFLP were reviewed. AFLP and HELLP syndrome shared common clinical, laboratory, histological and genetic features, and differential diagnosis between them was often difficult. However, HELLP syndrome was likely to occur in patients with hypertension, but AFLP occurred often in the absence of hypertension. In addition, AFLP was exclusively associated with pregnancy-induced antithrombin deficiency (PIATD). Approximately 50% of patients with AFLP did not have thrombocytopenia at presentation. As the Swansea criteria for AFLP did not include PIATD, diagnosis of AFLP was delayed until manifestation of life-threatening complications; 60% of women were admitted to intensive care and 15% to a specialist liver unit. In conclusion, incorporation of AT activity of less than 65% into the diagnostic criteria for AFLP may facilitate suspicion and prompt diagnosis of AFLP, decrease uncertainty regarding the diagnosis of AFLP, and contribute to better investigation and understanding of the process leading to the development of liver dysfunction.
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Affiliation(s)
- Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Cheng N, Xiang T, Wu X, Li M, Xie Y, Zhang L. Acute fatty liver of pregnancy: a retrospective study of 32 cases in South China. J Matern Fetal Neonatal Med 2014; 27:1693-7. [PMID: 24304174 DOI: 10.3109/14767058.2013.871704] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe 32 cases of acute fatty liver of pregnancy (AFLP) and identify the potential clinical predictors of maternal and fetal outcomes in South China. METHODS Thirty-two cases of AFLP previously treated in the First Affiliated Hospital of Nanchang University in the past 10 years were enrolled in the current study. RESULTS Sex of fetus and delivery method was the potential clinical predictor of fetal outcome. The main manifestations of AFLP were jaundice (n = 32), nausea and vomiting (n = 28), malaise (n = 25), and ascites (n = 25), and its complications included acute renal failure (n = 26), hepatic encephalopathy (n = 17), infection (n = 10), and postpartum hemorrhage (n = 7). Evidence of fatty changes of liver was demonstrated by B ultrasound and computed tomography (CT). Eighteen patients were recovered due to rapid diagnosis, early termination of pregnancy and supportive treatments. CONCLUSIONS Male sex and vaginal delivery was the risk factor of fetal outcome. Detailed history taking and proper management of potential predictors are important in making the decision of prompt delivery and choosing the appropriate delivery method. Further studies are needed to expand our knowledge on this disease.
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Affiliation(s)
- Na Cheng
- Department of Infectious Diseases, the First Affiliated Hospital of Nanchang University, Nanchang, China and
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Ahmed KT, Almashhrawi AA, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: Diseases unique to pregnancy. World J Gastroenterol 2013; 19:7639-7646. [PMID: 24282353 PMCID: PMC3837262 DOI: 10.3748/wjg.v19.i43.7639] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/05/2013] [Accepted: 09/05/2013] [Indexed: 02/06/2023] Open
Abstract
Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. This review summarizes liver diseases that are unique to pregnancy. We discuss clinical conditions that are seen only in pregnant women and involve the liver; from Hyperemesis Gravidarum that happens in 1 out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy (0.5%-1.5% prevalence), to the more frequent condition of preeclampsia (10% prevalence) and its severe form; hemolysis, elevated liver enzymes, and a low platelet count syndrome (12% of pregnancies with preeclampsia), to the rare entity of Acute Fatty Liver of Pregnancy (incidence of 1 per 7270 to 13000 deliveries). Although pathogeneses behind the development of these aliments are not fully understood, theories have been proposed. Some propose the special physiological changes that accompany pregnancy as a precipitant. Others suggest a constellation of factors including both the mother and her fetus that come together to trigger those unique conditions. Reaching a timely and accurate diagnosis of such conditions can be challenging. The timing of the condition in relation toward which trimester it starts at is a key. Accurate diagnosis can be made using specific clinical findings and blood tests. Some entities have well-defined criteria that help not only in making the diagnosis, but also in classifying the disease according to its severity. Management of these conditions range from simple medical remedies to measures such as immediate termination of the pregnancy. In specific conditions, it is prudent to have expert obstetric and medical specialists teaming up to help improve the outcomes.
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Tang WX, Huang ZY, Chen ZJ, Cui TL, Zhang L, Fu P. Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series. J Artif Organs 2011; 15:176-84. [DOI: 10.1007/s10047-011-0621-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 11/09/2011] [Indexed: 12/13/2022]
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Vigil-de Gracia P, Montufar-Rueda C. Acute fatty liver of pregnancy: diagnosis, treatment, and outcome based on 35 consecutive cases. J Matern Fetal Neonatal Med 2011; 24:1143-6. [PMID: 21668324 DOI: 10.3109/14767058.2010.531325] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We describe our experience with the clinical diagnosis, management and, course of patients with acute fatty liver of pregnancy (AFLP). METHODS 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. RESULTS 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%). CONCLUSION 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.
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Affiliation(s)
- Paulino Vigil-de Gracia
- Critical Care Unit, Department of Obstetrics and Gynecology, Social security, Panama, Panama.
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Collyer T, Holbrook S, Lyons G. Anaesthetic management of the pregnant patient with liver disease. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2011.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bacq Y. Liver diseases unique to pregnancy: a 2010 update. Clin Res Hepatol Gastroenterol 2011; 35:182-93. [PMID: 21310683 DOI: 10.1016/j.clinre.2010.11.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/19/2010] [Accepted: 11/23/2010] [Indexed: 02/08/2023]
Abstract
Liver disorders occurring during pregnancy may be specifically pregnancy-related, or may be due to an intercurrent or chronic liver disease, which may present in anyone, pregnant or not. This review focuses on the liver diseases unique to pregnancy. Hyperemesis gravidarum, which occurs during early pregnancy, may be associated with liver dysfunction. Intrahepatic cholestasis of pregnancy typically occurs during the second or third trimester. Pruritus and the associated biological signs of cholestasis improve rapidly after delivery. Mutations in gene encoding biliary transporters, especially ABCB4 encoding the multidrug resistance 3 protein, have been found to be associated with this complex disease. Ursodeoxycholic acid is currently the most effective medical treatment in improving pruritus and liver tests. Pre-eclampsia, which presents in late pregnancy frequently involves the liver, and HELLP syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets) is a life-threatening complication. Prognosis of acute fatty liver of pregnancy has been radically transformed by early delivery, and clinicians must have a high index of suspicion for this condition when a woman presents nausea or vomiting, epigastric pain, jaundice, or polyuria-polydipsia during the third trimester. Acute fatty liver of pregnancy has been found to be associated with a defect of long-chain 3-hydroxyacyl coenzyme A dehydrogenase in the fetus, and mothers and their offspring should undergo DNA testing at least for the main associated genetic mutation (c.1528G>C).
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Affiliation(s)
- Yannick Bacq
- Service d'hépatogastro-entérologie, hôpital Trousseau, Tours cedex, France.
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Abstract
Liver diseases related to pregnancy may be associated with preeclampsia (liver dysfunction related to preeclampsia; hemolysis, elevated liver enzymes, and low platelets with or without preeclampsia [HELLP syndrome]; and acute fatty liver of pregnancy) or may not involve preeclampsia (hyperemesis gravidarum and intrahepatic cholestasis of pregnancy). Liver diseases associated with pregnancy have unique presentations, but it can be difficult differentiating these from liver diseases that occur coincidentally with pregnancy. Recently, advances have been made in the disease mechanism and intervention of pregnancy-related liver diseases. Early diagnosis and delivery remains the key element in managing the liver diseases associated with preeclampsia, but emerging data suggest that incorporating advance supportive management into current strategies can improve both maternal and fetal outcomes.
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Affiliation(s)
- Calvin Pan
- Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, PO Box 1123, New York, NY 11355, USA.
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Rodríguez J, Rojas V, Gredilla E, Gilsanz F. [Liver failure in a woman with acute fatty liver of pregnancy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:325-326. [PMID: 20527354 DOI: 10.1016/s0034-9356(10)70240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
Viral hepatitis can be caused by the hepatitis A, B, C, D and E viruses. In the Western world, hepatitis A, B or C do not seem to influence the course of pregnancy, whereas hepatitis E infection, when contracted during the second or third trimester, seems to have a higher risk of developing into a fulminant hepatitis. Mother-to-infant transmission of hepatitis A seems to be very uncommon. The majority of HBsAg-positive and HBeAg-positive mothers can transmit the disease vertically. The timing of transmission is predominantly peripartum, and newborns of HBsAg-positive mothers should receive hepatitis B immunoglobulins within 12 h of birth, with HBV vaccine at birth and 1 and 6 months later. Hepatitis C is more often a chronic disease. Vertical transmission of hepatitis C is considered to be relatively rare but high viraemia or coinfection with HIV can increase this risk. There is currently no treatment to prevent this vertical transmission and pregnancies among HCV-positive mothers should not be discouraged. Infants should be tested for anti-HCV at 1 year and followed for the development of hepatitis. Breast feeding does not seem to play an important role in the transmission of hepatitis B and C.
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Affiliation(s)
- Simona Fiore
- University of Milan Medical School, Sacco Clinical Sciences Institute, Department of Obstetrics and Gynaecology, Via GB Grassi 74, 20157 Milan, Italy.
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Comment confirmer le diagnostic de stéatose hépatique aiguë gravidique en urgence ? ACTA ACUST UNITED AC 2009; 37:246-51. [DOI: 10.1016/j.gyobfe.2008.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 11/12/2008] [Indexed: 12/17/2022]
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Abstract
Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, particularly from certain geographical areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (oestrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include downregulation of the p65 component of nuclear factor (NF-kappaB) with a predominant T-helper type 2 (Th2) bias in the T-cell response along with host susceptibility factors, mediated by human leucocyte antigen expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review the possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.
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Affiliation(s)
- Udayakumar Navaneethan
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
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Abstract
Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, particularly from certain geographical areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (oestrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include downregulation of the p65 component of nuclear factor (NF-kappaB) with a predominant T-helper type 2 (Th2) bias in the T-cell response along with host susceptibility factors, mediated by human leucocyte antigen expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review the possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.
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Affiliation(s)
- Udayakumar Navaneethan
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Mayar Al Mohajer
- Department of Internal Medicine, University of Cincinnati Medical Center, Ohio, USA
| | - Mohamed T Shata
- Associate Research Prof. of Medicine, Division of Digestive diseases University of Cincinnati College of Medicine, Ohio, USA
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Heneghan MA, Selzner M, Yoshida EM, Mullhaupt B. Pregnancy and sexual function in liver transplantation. J Hepatol 2008; 49:507-19. [PMID: 18715668 DOI: 10.1016/j.jhep.2008.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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Hepburn IS, Schade RR. Pregnancy-associated liver disorders. Dig Dis Sci 2008; 53:2334-58. [PMID: 18256934 DOI: 10.1007/s10620-007-0167-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 11/26/2007] [Indexed: 12/14/2022]
Abstract
Liver disorders associated with pregnancy include hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), preeclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP), and acute fatty liver of pregnancy (AFLP). These conditions are relatively common and unique to pregnancy and are more likely to occur at certain terms of gestation specific to each condition. They can be associated with significant maternal and fetal morbidity and mortality. Although managing such patients may be very challenging, spontaneous resolution of the disease occurs shortly after termination of the pregnancy, usually without hepatic sequellae. Early diagnosis and timely treatment is a key to therapeutic success. This article explores the clinical features, pathophysiology, and management of these disorders.
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Affiliation(s)
- Iryna S Hepburn
- Department of Medicine, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
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