Research
Obstetrics
Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery

Presented in part as posters at the 32nd annual meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Feb. 6-11, 2012.
https://doi.org/10.1016/j.ajog.2013.07.006Get rights and content

Objective

Our aim was to provide a description of clinical and laboratory finding: pregnancy outcomes in women with acute fatty liver of pregnancy (AFLP). We also characterize the duration of recovery of multiorgan system dysfunction that begins after delivery.

Study Design

All women who were admitted to Parkland Hospital with AFLP were identified; their clinical and laboratory findings, pregnancy outcomes, and postpartum resolution of AFLP were reviewed.

Results

Between 1975 and 2012, there were 51 women who were identified to have AFLP. The most common complaints were persistent nausea and vomiting (57%), hypertension (57%), and abdominal pain (53%). More than 90% of these women had at least 1 of these findings or combinations thereof. A combination of hepatic and renal dysfunction was nearly universal, but with variable severity. Procoagulant synthesis was impaired in more than three-fourths of the women, which served to intensify obstetric hemorrhage for which 50% of the 51 women received blood and component transfusions. The stillbirth rate was 120 of 1000 pregnancies, and there were 2 maternal deaths. Composite recovery times of various markers of hepatic and renal function indicated normalization of most laboratory values within 7-10 days after delivery.

Conclusion

The clinical features and laboratory findings of women with AFLP derive from the central pathologic process: liver failure. After delivery, clinical recovery typically is seen within 3-4 days; however, laboratory abnormalities can persist for much longer.

Section snippets

Materials and Methods

From 1975-2012, ≥1 of the investigators were involved in the care of women who were admitted to Parkland Hospital with a diagnosis of AFLP. These names were entered into a registry, and with approval from the Institutional Review Boards at the University of Texas Southwestern Medical Center and Parkland Hospital, data were extracted from these medical records. For the entire study period, the criteria for diagnosis included evidence of acute liver failure with characteristic clinical findings

Results

From 1975-2012, there were 51 women with AFLP. Of these, 48 women were from the Parkland Hospital obstetrics population, and the 3 women were transferred from area hospitals. During this 38-year period, approximately 492,000 women were delivered at our hospital; thus, the frequency of AFLP was 1 per 10,000 births. With the exception of a propensity for twin gestations of 14%, their demographic characteristics were similar to women from our general obstetrics population. Their mean maternal age

Comment

We identified 51 women with acute fatty liver disease of pregnancy during this 38-year period for a frequency at Parkland Hospital of 1 per 10,000 births. This frequency compares with reported estimates of 1:7000 for Los Angeles County Hospital and 1:20,000 for the United Kingdom.9, 11 The complications and pregnancy outcomes shown in Table 2 for these women are similar to those from 6 recent reports and confirm that most morbidity that is associated with AFLP is collateral to liver failure.9,

References (29)

  • Tarnier

    Note sur l’etat graisseux du foie dans la fievre puerperale

    C R Soc Biol (Paris)

    (1857)
  • O. Lomer

    Ueber die Bedeutung des Icterus gravidarum, etc

    Zeitschr f Geb u Gyn

    (1886)
  • J.W. Williams

    Obstetrics: a textbook for students and practitioners

    (1903)
  • H. Stander et al.

    Acute yellow atrophy of the liver in pregnancy

    Am J Obstet Gynecol

    (1934)
  • Cited by (104)

    • Magnetic Resonance Imaging of Acute Abdominal Pain in the Pregnant Patient

      2022, Magnetic Resonance Imaging Clinics of North America
    • Platelets, Coagulation, and the Liver

      2021, Chesley’s Hypertensive Disorders in Pregnancy
    View all citing articles on Scopus

    The authors report no conflict of interest.

    Cite this article as: Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol 2013;209:456.e1-7.

    View full text