Acute Fatty Liver Of Pregnancy: Our Experience with Six Cases
Keywords:
CAESAREAN, JAUNDICE, METABOLIC ACIDOSIS, LIVER FAILURE.
Abstract
Background: AFLP is a rare, life-threatening pregnancy associated disorder manifesting in the late trimester or early postpartum period. Early diagnosis and treatment is very important due to multi organ involvement and high mortality.Method: Ours is a retrospective case study of AFLP in Amrita Institute of Medical Sciences &Research Centre, Kochi during the 2years of september 2013 to august 2015.Clinical presentations and management details were extracted from records.Results: Out of 6 cases, 5 were primi and 1 mutigravida. The mean gestational age of diagnosis was 36.67 weeks. The clinical features were vomiting in 2,jaundice in 5, pruritus in 2,encephalopathy in 2.Ultrasonography were done in all the 6 cases . Fatty liver in 3, ascites in 6 and bright liver were seen in 2. Labor induction with vaginal delivery in 1 and 5 had Caesarean delivery under general anaesthesia.The post op complications were acute renal insufficiency in 5 , liver failure in 3, pancreatitis in 1, metabolic acidosis in 5 ,pleural effusion in 3, pulmonary edema in 5, pneumonia in 2, sepsis in 5,hypoglycemia in 3, DIC in 3 , ARDS in 3, MODS in 3, maternal mortality in 3 and perinatal mortality in 1. Ventilatory support were given in 5 and ionotropes were used in 3. Blood & blood products were given in 5. The average duration of stay in the hospital and ICU were 12.7days and 4.8 days respectively.Conclusion: AFLP, a rare pregnancy related conditon with multi-organ failure and increased maternal and neonatal mortality. Aggressive management which includes maternal stabilization, rapid termination of pregnancy and intensive care support with multidisciplinary approach is important in reducing the complications associated with it.References
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2. Riely CA. Acute fatty liver of pregnancy. Semin Liver Dis. 1987;7:47–54.
3. Suchi Dwivedi,Ma Runmei. Retrospective Study of Seven Cases with Acute Fatty Liver of PregnancyISRN Obstetrics and Gynecology Volume 2013 (2013) .
4.Gregory TL. Hughes S. Coleman MA. De Silva. A. 2007. Acute fatty liver of pregnancy; three cases and discussion of analgesia and anesthesia. International Journal of Obstetric Anesthesia.16 (2):175-9.
5.P Sinha, P Kyle, P Gubbala. Acute Fatty Liver of Pregnancy - A Review:. The Internet Journal of Gynecology and Obstetrics. 2009 Volume 13 Number 1
6.Hin Hin Ko,Yoshida. Acute fatty liver of pregnancy Can J Gastroenterol. 2006 Jan; 20(1): 25–3.
7. Woll PJ, Record CO. Lactate elimination in man: Effects of lactate concentration and hepatic dysfunction. Eur J Clin Invest. 1979;9:397–404.
8. Werner CJ, Zoller DP, Baskin WN, Eichmann RE. Acute fatty liver of pregnancy associated with maternal and fetal metabolic acidosis. J Fam Pract. 1988;26:198–9.
9. Yucesoy G, Ozkan SO, Bodur H, Cakiroglu Y, Caliskan E, Ozeren S. 2005. Acute fatty liver of pregnancy complicated with disseminated intravascular coagulation and haemorrhage: a case report. International Journal of Clinical Practice. Supplement (147):82-4.
10. D. Joshi, A. James, A. Quaglia, R. H. Westbrook, and M. A. Heneghan, “Liver disease in pregnancy,” The Lancet, vol. 375, no. 9714, pp. 594–605, 2010.
11. Moldenhauer JS, O’brien JM, Barton JR, Sibai B. Acute fatty liver of pregnancy associated with pancreatitis: A life-threatening complication. Am J Obstet Gynecol. 2004;190:502–5.
12. Pereira SP, O’Donohue J, Wendon J, Williams R. Maternal and perinatal outcome in severe pregnancy-related liver disease. Hepatology. 1997;26:1258–62.
Published
2016-09-01
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