ACUTE FATTY LIVER OF PREGNANCY

DR. YOGESH RATHODDR. NIRAV KOTAKDEPARTMENT OF

ANAESTHESIOLOGYSETH GSMC & KEMH

MUMBAI

A 26 -YEAR-OLD WOMANprimigravida with 3 months amenorrhea got admitted for altered mental status and low urine output. She had ascites and encephalopathy. She underwent D & C under LA & sedation. Post-op 2nd day she had multi organ failure and she died the next day. Discuss the course of the disease, treatment protocols and anesthetic implications.

Acute fatty liver of pregnancy (AFLP), or reversible peripartum liver failure, occurs in up to 1 per 7,000 pregnancies and is more common in twin gestations.

characterized by microvesicular fatty infiltration of the liver (and possibly kidney) believed to be due to defective beta oxidation of fat, usually in the third trimester.

in 30% to 80% of pregnancies in which the fetus was found to have a long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) deficiency.

Incidence <0.01 %Presentation 3rd trimesterSymptoms, Signs & Complications- Nausea- Vomiting- Abdominal pain- Jaundice- Hepatic failure

AFLP is a medical emergency that demands rapid evaluation and treatment.

Hepatic failure and fetal death may occur within days.

Laboratory findings are- Low platelet count- Hypoglycemia- Mild to moderate elevation in aminotransferase levels

Treatment Management includes control of hypertension, seizure

prophylaxis, and immediate delivery of the fetus or termination of the pregnancy. Mode of delivery is not as critical as is doing so expeditiously. Liver transplantation may be indicated in severe cases

Outcome Maternal Death Rate < 12%Fetal Death Rate < 66%

Neuraxial Anesthesia can worsen the situation.

General Anesthesia is preferable.

The anesthesiologist should anticipate postpartum hemorrhage, establish adequate intravenous access, and ensure that cross matched blood is immediately available for any parturient with AFLP. There is often a worsening of liver function, renal function, and coagulopathy for 48 hours after delivery, followed by improvement during the subsequent weeks.