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:
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
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