Acute fatty liver of pregnancy.
OBJECTIVE
Acute fatty liver of pregnancy (AFLP) is a rare and serious entity associated with significant maternal and neonatal mortality and morbidity. We describe our experience with the clinical diagnosis, management and course patients with AFLP.


METHODS
Medical records of patients with AFLP were reviewed over a 10-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes.


RESULTS
The incidence of AFLP was 1 in 7,270 births. The mean gestational age at onset was 34.6 +/- 4.9 weeks. Eight percent of the patients were multiparous with more than three pregnancies. The prodromic phase was variable; patients complained of nausea, abdominal pain, malaise, polyuria-polydipsia syndrome and headaches followed by jaundice. The laboratory results indicated coagulopathy, liver function abnormalities and hypoglycemia. Emergency cesarean section was performed in two cases. The diagnosis has been assessed by transcutaneous hepatic biopsies processed in all patients between the 4th and 15th day (8.4 +/- 4.3 days). Maternal morbidity included hypoglycaemia (40%), coagulopathy (50%) encephalopathy (30%) and renal failure (40%). There were no maternal deaths but fetal mortality is high 66%.


CONCLUSIONS
The early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved.
Mjahed
Khalid
K
Department of Anaesthesia and Intensive Care, Ibn Rochd University Hospital, 125, Rue Larache Hay Essalam C.I.L, Casablanca, 20 200, Morocco. kmjahed@yahoo.fr
Charra
Boubker
B
Hamoudi
Driss
D
Noun
Mohamed
M
Barrou
Lhoucine
L
D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D005234:Fatty Liver / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007902:Length of Stay; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000503:physiopathology*; D011517:Prothrombin Time; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood
D000637:Transaminases; D001663:Bilirubin