Acute Fatty Liver of Pregnancy

Rare condition that occurs in the third trimester of pregnancy in which there is a rapid accumulation of fat within the liver cells causing acute hepatitis

Pathophysiology

  • Acute fatty liver of pregnancy results from impaired processing of fatty acids in the placenta
  • This is the result of a genetic condition in the fetus that impairs fatty acid metabolism
    • The most common cause is long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the fetus, which is an autosomal recessive condition

Clinical presentation

The presentation is with vague symptoms associated with hepatitis :
  • General malaise and fatigue
  • Nausea and vomiting
  • Jaundice
  • Abdominal pain
  • Anorexia (lack of appetite)
  • Ascites

Investigations

  • Liver function tests will show elevated liver enzymes (ALT and AST)
  • Other bloods may be deranged, with:
    • Raised bilirubin
    • Raised WBC count
    • Deranged clotting (raised prothrombin time and INR)
    • Low platelets

Management

  • Acute fatty liver of pregnancy is an obstetric emergency and requires prompt admission and delivery of the baby
  • Most patients will recover after delivery
  • Management also involves treatment of acute liver failure if it occurs, including consideration of liver transplant