Acute liver disease

Question 1

Define acute liver disease in pregnancy.

Answer 1

Rare pregnancy associated disorder of fatty infiltration of liver.

Question 2

Explain the aetiology of acute liver disease in pregnancy.

Answer 2

Likely due to mitochondrial dysfunction of fatty acid oxidation.

Question 3

What are the risk factors for acute liver disease in pregnancy?

Answer 3

Nulliparity

Male fetus

Multiple pregnancies

Obesity

Pre-eclampsia

Question 4

Summarise the epidemiology of acute liver disease in pregnancy.

Answer 4

5/100k pregnancies

Question 5

What are the symptoms of acute liver disease in pregnancy?

Answer 5

Non-specific symptoms.

In 3rd trimester, nausea, vomiting, swelling, abdominal pain, jaundice, bleeding.

Question 6

What are the signs of acute liver disease in pregnancy?

Answer 6

Liver tenderness

Ascites

Coagulopathis (petechiae/purpura/bruising)

50% have proteinuric HTN

Question 7

What investigations should be performed for acute liver disease in pregnancy?

Answer 7

FBC (Hb, Pl)

Clotting (Alb, studies)

LFT (high transaminases/BR)

Glucose

Question 8

What is the management for acute liver disease in pregnancy?

Answer 8

Delivery necessary urgent to stop progression

Fluid support, correct hypoglycaemia, blood transfusion, care of preterm neonate.

Correct coagulopathy with FFP/cryoprec if severe.

Liver transplant rarely necessary.

Question 9

What are the complications associated with acute liver disease in pregnancy? What is the prognosis of acute liver disease in pregnancy?

Answer 9

Maternal death (20%), hemorrage, renal failure, encephalopathy, sepsis or pancreatitis. Fetal death (30%).