Acute Fatty Liver Of Pregnancy

Question 1

What are the factors that associated with AFLP ?

Answer 1

1- primigravidae
2- low BMI < 20
3- multiple pregnancy
4- male fetuses ratio 3:1

Question 2

What is the maternal mortality & perinatal mortality in AFLP?

Answer 2

Maternal mortality 2 %
Perinatal mortality 11 %

Question 3

When does ALP usually present in pregnancy?

Answer 3

After 30 weeks, often near term
35- 36 weeks

Question 4

What are the clinical symptoms of ALP ?

Answer 4

1- onset: nausea/ anorexia / malaise
2- severe vomiting 60 %
3- abdominal pain 60 %

Question 5

What are the clinical & laboratory findings in women with ALP ?

Answer 5

1- coexistence of mild PET ( ⬆️BP+proteinuria : mild)
2- LFTs : ⬆️ transaminas ( 3-10 folds)
⬆️ alkaline phosphatase
3- coagulopathy : DIC 90 %
Often without thrombocytopenia
[presenting feature postpartum ]
4- acute kidney injury AKI
5- lactic acidosis
6- ⬆️ ammonia
7- hyperuricemia ( 90 %)
8- hypoglycemia 70%
9- fulminant liver failure 👉 hepatic
encephalopathy
10- polyuria + polydipsia: Diabetes insipidus DI ( كاذب)

Question 6

What is the management in ALP ?

Answer 6

1- Correct coagulopathy: FFP + Vit K
2- correct hypoglycemia: 10 - 50 % glucose
3- Antibiotics
4 - N- ACETYLCYSTEINE ***
5- if excessive urine: Desmopressin
❤ Delivery is the correct treatment once hypoglycemia & coagulopathy & hypertension have been controlled

Question 7

What is the recurrence rate of ALP in future pregnancies?

Answer 7

25%
Because ALP is associated with mutation of gene related to LCHAD in 19 % of cases