Acute fatty liver of pregnancy: diagnosis and management of 8 cases

Objective To investigate the early recognition and management of acute fatt y liver of pregnancy (AFLP) to improve maternal and fetal survival. Methods Eight cases of AFLP seen in our hospital during the past three year s were studied retrospectively. Symptoms, laboratory findings, timing of li ver biopsy, and maternal and fetus outcome were assessed. Results The mean gestational age at onset was 34 +/- 2 weeks. All cases wer e primigravida. In the early stages, all patients presented malaise, nausea , vomiting and epigastric distress followed by jaundice in the third trimes ter of pregnancy. Laboratory findings: all had raised transaminases and ser um bilirubin (32.5-510.8 mu mol/L), hypoalbuminemia (22.4-30.0 g/L), hypofi brinogenemia (<180 mg/dl), prolonged prothrombin time and prolonged partial thromboplastin time. Maternal complication included hepatic encephalopathy (6 cases), ascites (6), hypoglycemia (5), hematemesis (2), and postpartum hemorrhage (5) and preeclampsia (4). Emergency cesarean section was perform ed in 3 cases. One mother died of fulminant hepatic failure and the others survived. There was no fetus death. Liver biopsy was done on the 5th to 15t h postpartum day in 8 cases. Conclusion With increasing awareness, especially in the early recognition o f milder cases, and prompt progressive management including early terminati on of pregnancy by cesarean section and large dose infusion of fresh frozen plasma and albumin alternately, the prognosis of AFLP can be improved.