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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

1
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]
2
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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