title: Acute liver failure in pregnancy: Challenges and management.
abstract: Acute liver failure (ALF) in pregnancy negatively affects both maternal and foetal outcome. The spectrum of liver disease in pregnancy may range from mild asymptomatic transaminitis to fatal and irreversible deterioration in liver functions leading to significant morbidity and even mortality. In this comprehensive review, we searched articles published as review articles, clinical trials, and case series in the Medline from 1970 to 2012. The overall outcome of ALF in pregnancy depends on the aetiology, timely diagnosis, prompt management, and early referral to a centre equipped in managing medical or obstetric complication. The foetal outcome is affected by the stage of pregnancy in which the mother has a deterioration of the liver function, with a worst prognosis associated with first or second-trimester liver failure. When ALF complicates pregnancy, liver transplantation is the one of the viable options. Management protocols need to be individualised for each case keeping in mind the risk versus benefit to both the mother and the foetus.
authors.affiliation: Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
authors.forename: Chandra Kant
authors.initials: CK
authors.lastname: Pandey
authors.affiliation: Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
authors.forename: Sunaina Tejpal
authors.initials: ST
authors.lastname: Karna
authors.affiliation: Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
authors.forename: Vijay Kant
authors.initials: VK
authors.lastname: Pandey
authors.affiliation: Department of Anaesthesiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Tandon
keywords: Acute liver failure; liver transplantation; pregnancy; treatment strategies
references.citation: Acta Chir Belg. 2006 Sep-Oct;106(5):602-4
references.pmid: 17168279
references.citation: Indian J Gastroenterol. 2007 Jan-Feb;26(1):6-10
references.pmid: 17401226
references.citation: Int J Legal Med. 2005 Mar;119(2):103-6
references.pmid: 15744546
references.citation: Med Clin North Am. 1996 Sep;80(5):1167-87
references.pmid: 8804379
references.citation: N Engl J Med. 1996 Aug 22;335(8):569-76
references.pmid: 8678935
references.citation: Pediatrics. 2001 Aug;108(2):223-9
references.pmid: 11483781
references.citation: Transplantation. 1995 Sep 15;60(5):510-1
references.pmid: 7676503
references.citation: Liver Transpl. 2005 Feb;11(2):224-8
references.pmid: 15666378
references.citation: J Matern Fetal Neonatal Med. 2008 Aug;21(8):587-9
references.pmid: 18609350
references.citation: Eur J Gastroenterol Hepatol. 2005 Jan;17(1):33-5
references.pmid: 15647637
references.citation: Am Surg. 2007 Oct;73(10):1013-6
references.pmid: 17983071
references.citation: Am J Obstet Gynecol. 1993 Oct;169(4):1000-6
references.pmid: 8238109
references.citation: Transplantation. 1991 Nov;52(5):923-6
references.pmid: 1949180
references.citation: Liver Int. 2006 May;26(4):494-7
references.pmid: 16629654
references.citation: BMC Pregnancy Childbirth. 2009 Feb 26;9:8
references.pmid: 19245695
references.citation: Transplantation. 2004 Sep 15;78(5):782-3
references.pmid: 15371690
references.citation: Aliment Pharmacol Ther. 2004 Oct 15;20(8):867-73
references.pmid: 15479358
references.citation: Am J Obstet Gynecol. 1990 Feb;162(2):311-6
references.pmid: 2309811
references.citation: Eur J Pediatr. 1997 May;156(5):389-91
references.pmid: 9177983
references.citation: World J Gastroenterol. 2005 Aug 7;11(29):4600-3
references.pmid: 16052697
references.citation: Minerva Anestesiol. 2012 Apr;78(4):503-6
references.pmid: 21685863
references.citation: Lancet. 2010 Feb 13;375(9714):594-605
references.pmid: 20159293
references.citation: Obstet Gynecol. 1990 Dec;76(6):1083-8
references.pmid: 2234717
references.citation: Br J Anaesth. 1995 Jul;75(1):105-8
references.pmid: 7669448
references.citation: Clin Res Hepatol Gastroenterol. 2011 Mar;35(3):182-93
references.pmid: 21310683
references.citation: J Hepatol. 2008 Dec;49(6):930-5
references.pmid: 18926590
references.citation: J Gastroenterol Hepatol. 2007 May;22(5):676-82
references.pmid: 17444855
references.citation: Gut. 2008 Jul;57(7):951-6
references.pmid: 18332072
references.citation: Liver Transpl. 2007 Oct;13(10):1428-34
references.pmid: 17902129
references.citation: Hepatology. 2004 Feb;39(2):500-8
references.pmid: 14768004
references.citation: Eur J Obstet Gynecol Reprod Biol. 2001 Nov;99(1):57-65
references.pmid: 11604187
references.citation: Int J Obstet Anesth. 2007 Apr;16(2):175-9
references.pmid: 17275281
references.citation: Hepatology. 2005 May;41(5):1179-97
references.pmid: 15841455
references.citation: Crit Care Med. 2007 Nov;35(11):2498-508
references.pmid: 17901832
references.citation: Hepatology. 1990 Jan;11(1):59-64
references.pmid: 2403963
references.citation: Gastroenterology. 1989 Aug;97(2):439-45
references.pmid: 2490426
references.citation: Prog Liver Dis. 1970;3:282-98
references.pmid: 4908702
references.citation: Indian J Med Microbiol. 2003 Jul-Sep;21(3):184-5
references.pmid: 17643015
references.citation: Gynecol Obstet Invest. 2004;58(2):96-9
references.pmid: 15159596