Acute fatty liver of pregnancy: Difference between revisions

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==Background==
==Background== <!--T:1-->


<!--T:2-->
[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]]
[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]]
*Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum
*Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum
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==Clinical Features==
==Clinical Features== <!--T:3-->


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*Usually presents in 3rd trimester, but may occur any time in 2nd half of pregnancy to early postpartum
*Usually presents in 3rd trimester, but may occur any time in 2nd half of pregnancy to early postpartum
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]] (commonly severe)
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]] (commonly severe)
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==Differential Diagnosis==
==Differential Diagnosis== <!--T:5-->


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==Evaluation==
==Evaluation== <!--T:6-->




===Workup===
===Workup=== <!--T:7-->


<!--T:8-->
*[[Special:MyLanguage/LFTs|LFTs]]
*[[Special:MyLanguage/LFTs|LFTs]]
**ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy
**ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy
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===Diagnosis===
===Diagnosis=== <!--T:9-->


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*Often initially misdiagnosed as [[Special:MyLanguage/preeclampsia|preeclampsia]]/[[Special:MyLanguage/HELLP|HELLP]]
*Often initially misdiagnosed as [[Special:MyLanguage/preeclampsia|preeclampsia]]/[[Special:MyLanguage/HELLP|HELLP]]
**Hypoglycemia, jaundice, ascites, hypofibrinogenemia all ''more'' common in AFLP
**Hypoglycemia, jaundice, ascites, hypofibrinogenemia all ''more'' common in AFLP




====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>====
====Swansea criteria<==== <!--T:11-->


   
   
At least six of the following findings, in the absence of another cause:
<!--T:12-->
At least six of the following findings, in the absence of another cause:<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>
*[[Special:MyLanguage/Vomiting|Vomiting]]
*[[Special:MyLanguage/Vomiting|Vomiting]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
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*Microvesicular steatosis on liver biopsy
*Microvesicular steatosis on liver biopsy


==Management== <!--T:13-->


==Management==
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*Emergent Ob/Gyn consult
*Emergent Ob/Gyn consult
**Delivery typically results in rapid hepatic recovery
**Delivery typically results in rapid hepatic recovery
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==Disposition==
==Disposition== <!--T:15-->


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*Admit ICU or transfer to center with Ob
*Admit ICU or transfer to center with Ob




==See Also==
==See Also== <!--T:17-->




==External Links==
==External Links== <!--T:18-->




==References==
==References== <!--T:19-->


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<references/>
<references/>
[[Category:OBGYN]] [[category:GI]]
[[Category:OBGYN]] [[category:GI]]
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Latest revision as of 23:25, 12 January 2026

Other languages:

Background

Inferior view of the liver with surface showing lobes and impressions.
  • Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum
  • Exact etiology unclear, but thought to involve abnormal fetal fatty acid metabolism
  • Fat vesicles accumulate within hepatocytes, interfering with liver function


Clinical Features


Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Jaundice

Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis

Masqueraders

Only bilirubin stains the sclera

  • Carotenemia
  • Quinacrine ingestion
  • Dinitrophenol, teryl (explosive chemicals)


Evaluation

Workup

  • LFTs
    • ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy
    • Hyperbilirubinemia- more pronounced than in preeclampsia
  • BMP
  • DIC labs
  • CBC
  • UA
  • RUQ US
    • Non-specific; the liver can even be normal in echotexture
    • Useful to rule out other causes of obstructive biliary tract pathology.


Diagnosis

  • Often initially misdiagnosed as preeclampsia/HELLP
    • Hypoglycemia, jaundice, ascites, hypofibrinogenemia all more common in AFLP


Swansea criteria<

At least six of the following findings, in the absence of another cause:[2]

  • Vomiting
  • Abdominal pain
  • Polydipsia/polyuria
  • Encephalopathy
  • Elevated bilirubin
  • Hypoglycemia
  • Elevated urea
  • Leukocytosis
  • Ascites or bright liver on ultrasound scan
  • Elevated transaminases (AAT or ALT)
  • Elevated ammonia
  • Renal impairment: elevated creatinine
  • Coagulopathy: elevated prothrombin time or PT
  • Microvesicular steatosis on liver biopsy

Management


Disposition

  • Admit ICU or transfer to center with Ob


See Also

External Links

References

  1. ↑ Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30
  2. ↑ 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
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