Acute Fatty Liver Disease of Pregnancy in the Second Trimester

Afridi, Faraz; Feely, Michael; Reddy, Raju

doi:10.1155/2020/6705784

Cited by 4 publications

(7 citation statements)

References 15 publications

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“…A separate cohort analysis found that 19% of AFLP cases had mutations in the MTP α-subunit responsible for LCHAD deficiency [13]. Most cases of AFLP occur in the third trimester or early postpartum period, but there are case reports as early as the second trimester with the earliest reported case at 18 weeks of gestation [1][2][3][4][5][6]. Clinically, AFLP leads to liver failure but is also associated with renal failure, coagulopathy, hypoglycemia, encephalopathy, and multisystem organ failure [17][18][19]-all of which occurred in the presented case.…”

Section: Discussionmentioning

confidence: 99%

“…e pathophysiology remains unclear, but research has implicated defective mitochondrial fatty acid oxidation as a contributing factor. AFLP typically presents in the third trimester or early postpartum period, but rare cases have been described in the second trimester [1][2][3][4][5][6]. Diagnosis is usually based on the Swansea criteria [7] in conjunction with serologic and biochemical testing although liver biopsy can be performed under certain circumstances.…”

Section: Introductionmentioning

confidence: 99%

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Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

Hendrie

Blumer

Fenton

et al. 2021

Case Reports in Hepatology

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Acute fatty liver of pregnancy (AFLP) is a rare obstetric condition that classically presents in the third trimester or early postpartum period and can lead to liver failure and death. Only six second trimester AFLP cases have been reported in the English literature. We present the earliest case of AFLP at 15 weeks of gestation confounded by a high titer anti-nuclear antibody (ANA >1 : 1280) and concern for autoimmune hepatitis. Our patient had intrauterine fetal demise with prompt dilation and evacuation. Sepsis and multisystem organ failure ensued, and she was transferred to a liver transplant center where she expired without further intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

Hendrie

Blumer

Fenton

et al. 2021

Case Reports in Hepatology

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“…Her fetus was delivered at 19 weeks and 1 day of gestation. A PubMed search using the keywords "acute fatty liver of pregnancy" and "second trimester" revealed only five cases reported to date, which presented at 22, 3 23, 4 22, 5 19, 6 and 18 7 weeks' gestation with delivery at 20 weeks. 7 Therefore, to the best of our knowledge, this is the earliest AFLP diagnosis and pregnancy termination case to be reported.…”

Section: Discussionmentioning

confidence: 99%

Acute fatty liver of pregnancy at 19 weeks and 0 days of gestation after prolonged hyperemesis gravidarum

Komura¹,

Komatsu²,

Yamamoto³

et al. 2021

J of Obstet and Gynaecol

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Acute fatty liver of pregnancy (AFLP) is a rare disorder that typically develops in the third trimester. We successfully diagnosed and treated a case of AFLP that developed at 18 weeks' gestation. A 34-year-old woman-gravida 4, para 3-presented with continuous vomiting and abdominal pain and developed convulsive seizures and lost consciousness after transfusion therapy. Cerebral apoplexy was excluded by computed tomography of the brain. Blood tests revealed severe metabolic acidosis, coagulopathy, and leukocytosis, followed by severe hypoglycemia and elevated levels of transaminases and ammonia. The fetus was delivered dead. Whole-body computed tomography showed fatty liver. The patient was diagnosed with AFLP based on the Swansea criteria. AFLP may be a differential diagnosis in the second trimester, and rapid termination should be considered as radical treatment. Starvation may be a risk factor for this disorder.

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“…Múltiples estudios han sugerido que no es esencial solicitar la biopsia hepática, únicamente en los casos en los que el diagnóstico es incierto (12,17). Para el diagnóstico de esta patología existen los criterios de Swansea, los cuales incluyen síntomas y alteraciones de laboratorios (los cuales se muestran en la tabla 1), que se utilizan únicamente a partir del tercer trimestre (4,18). Estos criterios fueron validados en un gran estudio de cohorte realizado en el Reino Unido, y cuando esta herramienta fue aplicada a un gran número de pacientes con sospecha de enfermedades hepáticas del embarazo que fueron sometidas a biopsia hepática, estos tuvieron un valor predictivo positivo de 85% y un valor predictivo negativo del 100% para esteatosis hepática microvascular.…”

Section: Clínica Y Diagnósticounclassified

“…Ciertos casos podrían tardar hasta 4 semanas para su completa resolución, y el manejo de la coagulopatía podría continuar días o semanas después de la finalización del embarazo (4,6). Además, en el postparto inmediato se debe descartar la presencia de complicaciones potencialmente mortales como coagulación intravascular diseminada, insuficiencia renal aguda y hemorragias gastrointestinales (18). En la lesión renal aguda se podría realizar terapia de reemplazo renal con el fin de revertir los daños y prevenir la evolución de la enfermedad (23).…”

Section: Recurrencia En Futuros Embarazosunclassified

Hígado graso agudo del embarazo

2023

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El hígado graso agudo del embarazo (HGAE) es una grave complicación obstétrica que se presenta generalmente en el III trimestre, y se caracteriza por una insuficiencia hepática aguda debido a una infiltración grasa del hígado. Alrededor de un 3% de las mujeres pueden llegar a presentar alguna forma de enfermedad hepática durante su embarazo, siendo el HGAE una de las menos frecuentes; sin embargo, es potencialmente mortal para la madre y el feto. Aunque su fisiopatología es poco conocida, se han demostrado mutaciones genéticas tanto en la madre como en el feto en la beta oxidación de los ácidos grasos de cadena larga a nivel mitocondrial que conllevan a acumulación de metabolitos de ácidos grasos y daño por infiltración grasa en el hígado materno. Distinguir el HGAE de otras enfermedades hepáticas como el síndrome de HELLP y preeclampsia es un gran reto, por sus múltiples similitudes clínicas, por lo que se desarrollaron herramientas de diagnóstico sensibles, como los criterios de Swansea, para facilitar su diagnóstico temprano. La tasa de supervivencia ha aumentado en los últimos 30 años por la sospecha clínica y el importante manejo multidisciplinario entre obstetras, gastroenterólogos y anestesiólogos, evitando la aparición de complicaciones potencialmente mortales. Dicha enfermedad puede causar insuficiencia hepática, acompañada de insuficiencia renal, trastornos de la coagulación, hipoglucemia, encefalopatía y, a menudo, disfunción multiorgánica, por lo que requiere un parto temprano para su resolución.

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Acute Fatty Liver Disease of Pregnancy in the Second Trimester

Cited by 4 publications

References 15 publications

Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

Acute fatty liver of pregnancy at 19 weeks and 0 days of gestation after prolonged hyperemesis gravidarum

Hígado graso agudo del embarazo

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