Acute Fatty Liver in Pregnancy: A Rare but Catastrophic Complication of Late Pregnancy

Abstract

ABSTRACT
Acute fatty liver of pregnancy (AFLP) is a sudden catastrophic illness occurring almost exclusively in the
third trimester, where microvesicular fatty infiltration results in encephalopathy and hepatic failure.1
Although the exact pathogenesis is unknown but the disease has been linked to an abnormality in fetal
fatty acid metabolism. This abnormality is a deficiency in the LCHAD (long-chain 3-hydroxyacyl-coenzyme
A dehydrogenase) enzyme. Clinical manifestation usually manifests in the third trimester (35 to 36 weeks
of gestation) but some cases occur with a range of 28 to 40 weeks. The diagnosis of acute fatty liver of
pregnancy is challenging task for clinician because of the nonspecific clinical presentation which may
mimic conditions such as acute viral hepatitis, pre-eclampsia, HELLP syndrome. Ultrasound, CT, MRI
may be used to diagnose this disease. Liver biopsy is the gold standard for the diagnosis of AFLP. The
condition was previously thought to be universally fatal2
but aggressive treatment by stabilizing the
mother with intravenous fluids and blood products in anticipation of early delivery has improved
prognosis. Liver transplantation may be the option for severe liver failure patients. The mortality from
AFLP is approximately 18% and deaths are usually secondary to sepsis, renal failure, circulatory
collapse, pancreatitis or gastrointestinal bleeding.
KEY WORDS: Fatty, Liver, Pregnancy.