Acute fatty liver of pregnancy

Question 1

When does acute fatty liver of pregnancy usually occur?

Answer 1

3rd trimester

Question 2

Describe the pathophysiology of acute fatty liver of pregnancy

Answer 2

impaired processing offatty acidsin theplacenta. This is the result of a genetic condition in the fetus that impairs fatty acid metabolism. The most common cause islong-chain 3-hydroxyacyl-CoA dehydrogenase(LCHAD)deficiencyin the foetus, which is anautosomal recessivecondition. This mode of inheritance means the mother will also have one defective copy of the gene.

ThLCHAD enzymeis important infatty acid oxidation, breaking down fatty acids to be used as fuel. The fetus and placenta are unable to break down fatty acids. These fatty acids enter the maternal circulation, and accumulate in the liver. The mother’s defective copy of the gene may also contribute to the accumulation of fatty acids.The accumulation of fatty acids in the mother’s liver leads to inflammation and liver failure.

Question 3

Presentation of acute fatty liver of pregnancy

Answer 3

• General malaise and fatigue
• Nausea and vomiting
• Jaundice
• Abdominal pain
• Anorexia (lack of appetite)
• Ascites

Question 4

What will blood testing show in acute fatty liver of pregnancy

Answer 4

• Elevated LFTs (ALT and AST)
• Raised bilirubin
• Raised WBC count
• Deranged clotting (raised prothrombin time and INR)
• Low platelets
  (Be warned, HELPP syndrome is the more common cause of evaluated LFTs and low platelets)

Question 5

Management off acute fatty liver of pregnancy

Answer 5

Obstetric emergencyand requires prompt admission anddeliveryof the baby. Most patients will recover after delivery.

Management also involves treatment ofacute liver failureif it occurs, including consideration ofliver transplant.