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Acute Fatty Liver of Pregnancy: Analysis on the Diagnosis and Treatment of 15 Cases.
J Reprod Med. 2016 May-Jun; 61(5-6):282-6.JR

Abstract

OBJECTIVE

To describe our experience with the diagnosis and management of acute fatty liver of pregnancy (AFLP).

STUDY DESIGN

The medical records of pregnant women with AFLP were reviewed for symptoms, laboratory findings, treatment, and maternal and fetal outcomes during a 10-year period between January 2003 and December 2013.

RESULTS

During the study period 15 women had AFLP as their discharge diagnosis. The mean gestational age at onset was 36 ± 1 weeks. Eleven cases were primigravidas, and 2 had multiple gestations. All patients presented with nausea, vomiting, and epigastric distress followed by jaundice in the third trimester of pregnancy. Raised transaminases and serum bilirubin as well as coagulopathy were found in all patients (100%), while hypoglycemia was found in 8 patients (53%). Ultrasound examination showed enhanced echo or fatty liver in 11 patients. Maternal morbidity included hepatic encephalopathy (n = 1), renal failure (n = 3), ascites (n = 6), hypoglycemia (n = 8), postpartum hemorrhage (n = 6), upper gastrointestinal hemorrhage (n = 1), and preeclampsia (n = 1). Emergency cesarean section was performed in 12 cases and supracervical hysterectomy was performed in 1 patient due to postpartum hemorrhage and disseminated intravascular coagulation (DIC); all patients survived. All neonates survived except for 2 fetal death cases before admission.

CONCLUSION

Early diagnosis and prompt progressive management, including early termination of pregnancy and comprehensive supportive care, are crucial for improving the prognoses of both mother and newborn.

Authors

Liu G
No affiliation info available
Shang X
No affiliation info available
Yuan B
No affiliation info available
Han C
No affiliation info available
Wang Y
No affiliation info available

MeSH

Acute Kidney InjuryAdultAntihypertensive AgentsAscitesBlood Coagulation DisordersBlood TransfusionCesarean SectionDelivery, ObstetricDisseminated Intravascular CoagulationEarly DiagnosisEarly Medical InterventionFatty LiverFemaleFetal DeathFluid TherapyGastrointestinal HemorrhageGestational AgeGravidityHepatic EncephalopathyHumansInfant, NewbornMaleNauseaPostnatal CarePostpartum HemorrhagePre-EclampsiaPregnancyPregnancy ComplicationsPregnancy Trimester, ThirdPregnancy, MultiplePrognosisRetrospective StudiesYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27424373

Citation

Liu, Guoyan, et al. "Acute Fatty Liver of Pregnancy: Analysis On the Diagnosis and Treatment of 15 Cases." The Journal of Reproductive Medicine, vol. 61, no. 5-6, 2016, pp. 282-6.
Liu G, Shang X, Yuan B, et al. Acute Fatty Liver of Pregnancy: Analysis on the Diagnosis and Treatment of 15 Cases. J Reprod Med. 2016;61(5-6):282-6.
Liu, G., Shang, X., Yuan, B., Han, C., & Wang, Y. (2016). Acute Fatty Liver of Pregnancy: Analysis on the Diagnosis and Treatment of 15 Cases. The Journal of Reproductive Medicine, 61(5-6), 282-6.
Liu G, et al. Acute Fatty Liver of Pregnancy: Analysis On the Diagnosis and Treatment of 15 Cases. J Reprod Med. 2016 May-Jun;61(5-6):282-6. PubMed PMID: 27424373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Fatty Liver of Pregnancy: Analysis on the Diagnosis and Treatment of 15 Cases. AU - Liu,Guoyan, AU - Shang,Xiaobin, AU - Yuan,Bibo, AU - Han,Cha, AU - Wang,Yingmei, PY - 2016/7/19/entrez PY - 2016/7/19/pubmed PY - 2016/8/3/medline SP - 282 EP - 6 JF - The Journal of reproductive medicine JO - J Reprod Med VL - 61 IS - 5-6 N2 - OBJECTIVE: To describe our experience with the diagnosis and management of acute fatty liver of pregnancy (AFLP). STUDY DESIGN: The medical records of pregnant women with AFLP were reviewed for symptoms, laboratory findings, treatment, and maternal and fetal outcomes during a 10-year period between January 2003 and December 2013. RESULTS: During the study period 15 women had AFLP as their discharge diagnosis. The mean gestational age at onset was 36 ± 1 weeks. Eleven cases were primigravidas, and 2 had multiple gestations. All patients presented with nausea, vomiting, and epigastric distress followed by jaundice in the third trimester of pregnancy. Raised transaminases and serum bilirubin as well as coagulopathy were found in all patients (100%), while hypoglycemia was found in 8 patients (53%). Ultrasound examination showed enhanced echo or fatty liver in 11 patients. Maternal morbidity included hepatic encephalopathy (n = 1), renal failure (n = 3), ascites (n = 6), hypoglycemia (n = 8), postpartum hemorrhage (n = 6), upper gastrointestinal hemorrhage (n = 1), and preeclampsia (n = 1). Emergency cesarean section was performed in 12 cases and supracervical hysterectomy was performed in 1 patient due to postpartum hemorrhage and disseminated intravascular coagulation (DIC); all patients survived. All neonates survived except for 2 fetal death cases before admission. CONCLUSION: Early diagnosis and prompt progressive management, including early termination of pregnancy and comprehensive supportive care, are crucial for improving the prognoses of both mother and newborn. SN - 0024-7758 UR - https://www.unboundmedicine.com/medline/citation/27424373/Acute_Fatty_Liver_of_Pregnancy:_Analysis_on_the_Diagnosis_and_Treatment_of_15_Cases_ DB - PRIME DP - Unbound Medicine ER -