Case report: anesthetic management of acute fatty liver of pregnancy in the postpartum period.
Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder that manifests during the third trimester. Early diagnosis, termination of pregnancy, and treatment of complications associated with AFLP significantly reduce maternal morbidity and mortality. While most cases of AFLP occur before delivery, some may occur after vaginal delivery. Anesthesia providers should have a high level of suspicion for AFLP in a patient with altered mental status and elevated liver function test results in the postpartum period. Anesthetic implications include early recognition of liver dysfunction and aggressive resuscitation and treatment of hypoglycemia, disseminated intravascular coagulopathy, and other associated complications and reduction or avoidance of medications with substantial hepatic metabolism. This is a case report describing the management of a woman with AFLP in whom acute liver failure rapidly developed after a vaginal delivery with epidural analgesia at a small overseas hospital.
Spence
Dennis
D
Uniformed Services University of the Health Sciences, Nurse Anesthesia Program, Naval Medical Center San Diego, California, USA. dennis.spence@med.navy.mil
D000208:Acute Disease; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000451:nursing; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000451:nursing; D003422:Critical Care; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D042241:Early Diagnosis; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology; D009719:Nurse Anesthetists; D011181:Postnatal Care; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012151:Resuscitation