Acute fatty liver of pregnancy most frequently complicates the third trimester and is commonly associated (or complicated ) with preeclampsia (50 to 100 percent).
Incidence and Characteristics Riely CA. Hepatic disease in pregnancy. Am J Med 1994;96(1A):18S-22S. 3. Samuels P, Cohen AW. Pregnancies complicated by liver disease and liver dysfunction. Obstet Gynecol Clin North Am 1992;19:745-63
Liver function tests In normal pregnancies, alkaline phosphatase levels may be elevated three- to fourfold, secondary to placental alkaline phosphatase levels evaluate Cholestasis and biliary obstruction
Recent research suggests that AFLP is associated with a Glu474Gln mutation in the long-chain 3-hydroxy acyl-coenzyme A dehydrogenase (LCHAD), a fatty acid β oxidation enzyme.
Matern D, Hart P, Murtha AP, Vockley J, Gregersen N, Millington DS, et al. Acute fatty liver of pregnancy associated with short-chain acyl- coenzyme A dehydrogenase deficiency. J Pediatr 2001;138:585-8. . Brackett JC, Sims HF, Rinaldo P, et al. Two alpha subunit donor splice site mutations cause human trifunctional protein deficiency. J Clin Invest 1995;95:2076-82.
The upper gastrointestinal hemorrhage may be caused by Mallory-Weiss syndrome, acute gastric or duodenal lesions (e.g., gastritis, duodenitis, peptic ulcers), or it can be a manifestation of a coagulopathy.
Cano RI, Delman MR, Pitchumoni CS, et al: Acute fatty liver of pregnancy. Complication by disseminated intravascular coagulation
Killam AP, Dillard SH, Patton RC, et al: Pregnancy-induced hypertension complicated by acute liver disease and disseminated intravascular coagulation. Am J Obstet Gynecol 123:823, 1975
Ultrasound is most important in the exclusion of biliary tract disorders, but its value and the value of CT and MR imaging, has been considered limited and not helpful for the diagnosis and management of patients with AFLP.
Castro MA, Ouzounian JG, Colletti PM, et al: Radiologic studies in acute fatty liver of pregnancy. A review of the literature and 19 new cases. J Reprod Med 41:839, 1996
Moderate or severely affected patients (encephalopathic, deeply jaundiced, with a prothrombin time less than 40% of the control), or with any extrahepatic complications, should be attended in intensive care units.
Two laboratory tests: prothrombin time and blood glucose , should be repeated at least daily , Prothrombin time helps to assess the prognosis of liver failure, and blood glucose detects a severe hypoglycemia.