Acute Fatty Liver of Pregnancy

Reviewed 06/2017
 


BASICS

DESCRIPTION

  • A rare but serious diagnosis associated with significant maternal and neonatal morbidity and mortality

  • Microvesicular fatty infiltrate of the liver occurring during pregnancy

  • Is often ...

DIAGNOSIS

PHYSICAL EXAM

  • Prodromal symptoms of malaise followed by nausea and vomiting

  • Hypoglycemia

  • Metabolic acidosis, lactic acidosis

  • Jaundice

  • Encephalopathy

  • Ascites

  • Dehydration (dry mucous membranes, poor ...

TREATMENT

GENERAL MEASURES

  • Continuous maternal and fetal monitoring

  • Delivery as soon as possible

  • Consider cesarean section if remote from vaginal delivery.

  • Serial labs to trend

  • Monitor urine output via Fol...

ONGOING CARE

FOLLOWUP RECOMMENDATIONS

  • Continue to follow liver panel, chemistries, renal function, coagulation panel, complete blood count postpartum. Abnormalities can peak as late as postpartum day 2...

REFERENCES

Kamimura K, Abe H, Kawai H et al. Advances in understanding and treating liver diseases during pregnancy: a review. World J Gastroenterol.  2015;21(17):5183–5190. [View Abstract on Ov...

ADDITIONAL READING

  • Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol.  2013;209(5):456.e1–456.e7. [View A...

CODES

ICD10

  • K76.0 Fatty (change of) liver, not elsewhere classified

  • O26.619 Liver and biliary tract disord in pregnancy, unsp trimester

  • O26.611 Liver and biliary tract disord in pregnancy, first trimeste...

PEARLS

Stabilization of the mother, early recognition, and delivery are the keys for successful management. 

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