Acute Fatty Liver of Pregnancy

Cecilia M. Kipnis, MD, FAAFP and Matthew Feist, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

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

  • Due to a fetal/placental defect in β-oxidation of fatty acids, toxic...

DIAGNOSIS

PHYSICAL EXAM

  • Prodromal symptoms of malaise followed by nausea and vomiting

  • Jaundice, coagulopathy, encephalopathy, ascites

  • Dehydration (dry mucous membranes, poor skin turgor, delayed capillar...

TREATMENT

GENERAL MEASURES

  • Continuous maternal and fetal monitoring

  • Emergent delivery of fetus

  • Consider cesarean section if remote from vaginal delivery; must take into consideration maternal condition, ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

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

REFERENCES

Liu J, Ghaziani TT, Wolf JL. Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. Am J Gastroenterol.  2017;112(6):838–846.  [View Abstract]
Ko ...

ADDITIONAL READING

  • Ahmed KT, Almashhrawi AA, Rahman RN, et al. Liver diseases in pregnancy: diseases unique to pregnancy. World J Gastroenterol.  2013;19(43):7639–7646.

  • Kamimura K, Abe H, Kawai H,...

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...

CLINICAL PEARLS

  • AFLP should be considered with any transaminitis after the 20th week of pregnancy and in women with new onset vomiting and abdominal pain in the 3rd trimester.

  • AFLP is an obstetrical em...

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