Acute fatty liver of pregnancy

• acute fatty liver of pregnancy has a rapid onset in the third trimester. It has an unknown aetiology
  • there are however case reports revealing a correlation between pregnancy complications such as acute fatty liver of pregnancy and long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) deficiency in the foetus
    
    
• this disease results form accumulation of microvesicular fat in hepatocytes - this condition is associated with potentially rapid onset of liver failure
  
  
• it is rare - 1 in 7000 to 1 in 16000 pregnancies. Note however that a UK study revealed a significantly higher incidence of about 1 in 1,000 pregnancies
  
  
• it is associated with raised bilirubin and transaminase levels; other possible features include hyperuricaemia, thrombocytopaenia and pancreatitis
  
  
• clinical features include vomiting, abdominal pain, and headache. The mother will be jaundiced
  
  
• disease progression may lead to renal failure, clotting disorders and hypoglycaemia
  
  
• treatment involves hospitalisation, immediate delivery, and treatment of liver failure (and renal failure). There is a high maternal and foetal mortality associated with this condition
  • maternal mortality rate has been estimated at 18%, and neonatal mortality rates have ranged from 7% to 58%

Reference:

1. Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol. 2013 Nov;209(5):456.e1-7