Acute fatty liver of pregnancy; three cases and discussion of analgesia and anaesthesia.
Acute fatty liver of pregnancy is a rare, potentially fatal, complication of late pregnancy. The incidence is estimated at 1:7000-1:15000 pregnancies. Presentation is classically with malaise, nausea and vomiting, abdominal pain and rarely encephalopathy. Prolongation of laboratory clotting tests is an early feature. Ultrasound examination of the liver is performed to exclude biliary stasis. Rapid clinical deterioration may occur and urgent delivery should be organised. Anaesthetists form part of a multidisciplinary approach before, during and after delivery but there are few reports of anaesthetic involvement. One dilemma facing an anaesthetist called to assist in these cases is the potentially negative effect of general anaesthesia on hepatic encephalopathy versus the risks associated with regional anaesthesia in the presence of coagulopathy. Postoperative analgesia may also be complicated by impaired renal and hepatic function. We present three cases that occurred in our unit in a 6-month period illustrating the spectrum of disease severity and the successful use of different anaesthetic techniques to facilitate management including delivery.
Gregory
T L
TL
Department of Anaesthesia, Southampton General Hospital, Southampton, UK. tamsingregory@doctors.org.uk
Hughes
S
S
Coleman
M A
MA
De Silva
A
A
D015746:Abdominal Pain / Q000209:etiology; D000111:Acetylcysteine / Q000008:administration & dosage; D000208:Acute Disease; D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001794:Blood Pressure; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005313:Fetal Death / Q000209:etiology; D016166:Free Radical Scavengers / Q000008:administration & dosage; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D007792:Lactulose / Q000008:administration & dosage; D009325:Nausea / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy; D035583:Rare Diseases; D012720:Severity of Illness Index; D013610:Tachycardia / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D000900:Anti-Bacterial Agents; D016166:Free Radical Scavengers; D005765:Gastrointestinal Agents; D007792:Lactulose; D000111:Acetylcysteine