Acute fatty liver of pregnancy

Abstract

Acute fatty liver of pregnancy (AFLP) represents a serious obstetric complication which generally occurs in the III trimester, it is characterized by hepatic failure due to fatty infiltration of the liver. Approximately 3% of all pregnant women suffer of some kind of hepatic pathology during their pregnancy; AFLP is one of the rarest presentations nonetheless one of the deadliest both for the mother and fetus. Although the physiopathology of this disorder remains largely unknown, new studies have shown maternal and fetal genetic mutations in the mitochondrial beta oxidation of long chain fatty acids that lead to accumulation of fatty acids metabolites, which results in the mother’s liver damage due to fatty infiltration. The differential diagnosis between liver diseases in pregnancy is a challenge, especially with HELLP syndrome and preeclampsia, which share various clinical similarities with AFLP. Therefore, it is crucial to use sensitive diagnostic tools, like the Swansea criteria, which aids in an early diagnosis. The survival rate has improved in the last 30 years attributable to higher clinical suspicion and an adequate inter-disciplinary approach with obstetricians, gastroenterologists, and anesthesiologists, reducing the deadliest complications. AFLP can cause liver failure accompanied with renal insufficiency, coagulopathies, hypoglycemia, encephalopathy and often with multiorgan failure, hence it requires a prompt delivery for its resolution.