Acute Fatty Liver of Pregnancy
8/10/10
Frederic S.Bongard, Darryl Y. (2002) “CURRENT Critical Care Diagnosis & Treatment” 2nd
edition: Publisher: McGraw-Hill/Appleton & Lange
- essentials of diagnosis: hepatic dysfunction + microvesicular infiltration of hepatocytes
- thought to be a variant of PET
- fetal and maternal mortality = 20%
- aetiology unknown ?may be related to mother carrying fetus’ with disordered fat
metabolism
- often develop DI
HISTORY
- last trimester of pregnancy or immediately post partum
- primip
- multiple gestation
-
N+V
anorexia
malaise
epigastric pain/RUQ pain
EXAMINATION
-
often have hypertension
jaundice
abdominal tenderness
oedema
polyuria
- can develop: hepatic encephalopathy, ascites, hypoglycaemia, consumptive coagulopathy,
pancreatitis
INVESTIGATIONS
-
may have proteinuria
marked leukocytosis
normochormic, normocytic anaemia
fragmented RBCS
microangiopathic haemolytic anaemia
consumptive coagulopathy (DIC)
AST and ALT seldom > 1000I/L
ALP and bilirubin are elevated
severe hypoglycaemia
elevated lipase/amylase (pancreatitis)
hypernatraemia if has DI
liver biopsy
Jeremy Fernando (2011)
MANAGEMENT
- urgent delivery of fetus once mother stablised
Resuscitation
-
mum and baby
full monitoring
CTG/Ultrasound
haematological resuscitation (products, vitamin K)
hydralazine for hypertension
Acid-base and Electrolytes
- frequent monitoring
- intravascular volume correction
- hypoglycaemia treatment
Antidotes/Specific Treatments
- MgSO4 IV (adjust in renal failure)
- decrease protein intake (nutrition should be glucose based -> decrease hepatic metabolism
burden)
- lactulose to decrease ammonia production and absorption in the intestine -> diarrhoea
- if develops DI -> desmopressin
- liver transplantation
Underlying cause
- deliver baby (usually be EmC/S)
Jeremy Fernando (2011)