https://wikem.org/w/index.php?action=history&feed=atom&title=Acute_fatty_liver_of_pregnancy%2FenAcute fatty liver of pregnancy/en - Revision history2026-04-18T13:59:46ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Acute_fatty_liver_of_pregnancy/en&diff=379543&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T17:15:37Z<p>Updating to match new version of source page</p>
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==Background==<br />
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[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]]<br />
*Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum<br />
*Exact etiology unclear, but thought to involve abnormal fetal fatty acid metabolism <br />
*Fat vesicles accumulate within hepatocytes, interfering with liver function<br />
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==Clinical Features==<br />
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*Usually presents in 3rd trimester, but may occur any time in 2nd half of pregnancy to early postpartum<br />
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]] (commonly severe)<br />
*[[Special:MyLanguage/Jaundice|Jaundice]]<br />
*Findings consistent with [[Special:MyLanguage/preeclampsia|preeclampsia]] in some women:<br />
**[[Special:MyLanguage/Hypertension|Hypertension]]<br />
**Edema<br />
**[[Special:MyLanguage/Proteinuria|Proteinuria]]<br />
*[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]]<br />
*Often, signs/symptoms of [[Special:MyLanguage/DIC|DIC]]<br />
*+/- [[Special:MyLanguage/encephalopathy|encephalopathy]], [[Special:MyLanguage/ascites|ascites]]<br />
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==Differential Diagnosis==<br />
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{{Postpartum emergencies DDX}}<br />
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{{Jaundice DDX}}<br />
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==Evaluation==<br />
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===Workup===<br />
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*[[Special:MyLanguage/LFTs|LFTs]]<br />
**ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy<br />
**[[Special:MyLanguage/Hyperbilirubinemia|Hyperbilirubinemia]]- more pronounced than in preeclampsia<br />
*BMP<br />
**[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]]<br />
*[[Special:MyLanguage/DIC|DIC]] labs <br />
**Low fibrinogen, [[Special:MyLanguage/coagulopathy|coagulopathy]]<br />
**DIC present in as many as 70% of patients<ref>Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30</ref><br />
*CBC<br />
**Often shows [[Special:MyLanguage/leukocytosis|leukocytosis]]<br />
*[[Special:MyLanguage/UA|UA]]<br />
**[[Special:MyLanguage/Proteinuria|Proteinuria]]<br />
*[[Special:MyLanguage/RUQ US|RUQ US]]<br />
**Non-specific; the liver can even be normal in echotexture <br />
**Useful to rule out other causes of obstructive biliary tract pathology.<br />
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===Diagnosis===<br />
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*Often initially misdiagnosed as [[Special:MyLanguage/preeclampsia|preeclampsia]]/[[Special:MyLanguage/HELLP|HELLP]]<br />
**Hypoglycemia, jaundice, ascites, hypofibrinogenemia all ''more'' common in AFLP<br />
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====Swansea criteria<ref>Dey M, Reema K. Acute Fatty liver of pregnancy. N Am J Med Sci. 2012;4 (11): 611-2. doi:10.4103/1947-2714.103339</ref>====<br />
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At least six of the following findings, in the absence of another cause:<br />
*[[Special:MyLanguage/Vomiting|Vomiting]]<br />
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]<br />
*Polydipsia/polyuria<br />
*Encephalopathy<br />
*[[Special:MyLanguage/Elevated bilirubin|Elevated bilirubin]]<br />
*[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]]<br />
*Elevated urea <br />
*Leukocytosis <br />
*[[Special:MyLanguage/Ascites|Ascites]] or bright liver on ultrasound scan<br />
*Elevated transaminases (AAT or ALT) <br />
*Elevated ammonia <br />
*Renal impairment: elevated creatinine <br />
*Coagulopathy: elevated prothrombin time or PT<br />
*Microvesicular steatosis on liver biopsy<br />
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==Management==<br />
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*Emergent Ob/Gyn consult<br />
**Delivery typically results in rapid hepatic recovery<br />
*[[Special:MyLanguage/Dextrose|Dextrose]] for hypoglycemia<br />
*[[Special:MyLanguage/FFP|FFP]], [[Special:MyLanguage/cryoprecipitate|cryoprecipitate]], and/or [[Special:MyLanguage/platelets|platelets]] for [[Special:MyLanguage/coagulopathy|coagulopathy]] (see [[Special:MyLanguage/DIC|DIC]])<br />
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==Disposition==<br />
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*Admit ICU or transfer to center with Ob<br />
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==See Also==<br />
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==External Links==<br />
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==References==<br />
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<references/><br />
[[Category:OBGYN]] [[category:GI]]</div>FuzzyBot