Acute fatty liver of pregnancy (AFLP) – an overview

Ag, Rajasri; Srestha, R; Mitchell, Jessica

doi:10.1080/01443610701194705

Cited by 67 publications

(65 citation statements)

References 21 publications

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“…In our study, the maternal and fetal mortality rates were 16.5% and 22.4%, respectively, which was similar to those reported previously, (3,10) highlighting the vulnerability of patients with AFLP. There were 22 (16.5%) women with twin pregnancies in our study, which was similar to another study.…”

Section: Discussionsupporting

confidence: 80%

“…(2,8) With acceptance of the importance of early recognition and diagnosis of AFLP, prompt delivery and intensive supportive care, maternal mortality, which used to be as high as 85%, (9) has decreased and is in the range of 12.5% to 18% currently. (10) Simultaneously, neonatal mortality rate has also decreased, which is in the range of 7% to 66%. (3,11) Previous clinical studies on AFLP, largely based on a few patients due to its low prevalence, have found large variations in results vis-à-vis its epidemiology, (2)(3)(4)(5)(6) symptoms, (12) complications (12) and outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…(3,11) Previous clinical studies on AFLP, largely based on a few patients due to its low prevalence, have found large variations in results vis-à-vis its epidemiology, (2)(3)(4)(5)(6) symptoms, (12) complications (12) and outcomes. (3,10,11,13) For instance, Cheng et al (14) found that, besides aetiology, other clinical characteristics of pregnancy (e.g. primiparity, male fetus and multiparous women), which had been identified as potential risk factors in some other studies, (9,15) seemed to be partially insignificant statistically in their patients.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study

Gao

Chen

et al. 2018

smedj

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study

Gao

Chen

et al. 2018

smedj

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“…Nevertheless, the diagnosis of AFLP can be challenging to establish until the disorder is well advanced, as demonstrated in this small series and as reported by others [30,35]. In rare cases of extensive and intractable AFLP, liver transplant has been required when conservative, traditional therapy was inadequate to facilitate hepatic recovery [3,4,10,[36][37][38]. In a tertiary referral practice such as ours, we are more likely to receive in transport patients with AFLP that is more complicated and severe than more subtle cases that respond to delivery and traditional supportive medical care.…”

Section: Discussionmentioning

confidence: 71%

Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy

Martin

Briery

Rose

et al. 2008

J of Clinical Apheresis

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Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant fetal-maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory support, five had advanced liver insufficiency, and all six were developing renal failure. PPEX was initiated 2-8 days following delivery and repeated (two to four times, mean = 3) at 24-48-h intervals thereafter. All patients responded with composite clinical (symptoms/signs) and laboratory improvement; the average length of hospitalization following final PPEX for five of six patients was 7 days. No significant PPEX-related complications occurred. PPEX utilization in patients with severe AFLP may enhance maternal recovery by preventing secondary sequelae from hepatic insufficiency until spontaneous healing can occur. Further study appears to be indicated to validate a role for PPEX as supportive therapy for puerperal patients with AFLP suffering multiorgan failure.

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“…The diagnosis of LCHAD deficiency in newborns can save lives; therefore, all women with AFLP and their children should be administered a molecular test for LCHAD, which should at least evaluate the most common mutation, namely, G1528C [21,22] . In the present case, it was not possible to perform this type of test because it was not available.…”

Section: Discussionmentioning

confidence: 99%

Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

Oliveira¹,

Moreira²,

Baima³

et al. 2014

WJH

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Acute fatty liver of pregnancy is a rare disease that affects women in the third trimester of pregnancy. Although infrequent, the disease can cause maternal mortality. The diagnosis is not always clear until the pregnancy is terminated, and significant complications, such as acute pancreatitis, can occur. Pancreatic involvement typically only occurs in severe cases after the development of hepatic and renal impairment. To date, little knowledge is available regarding how the disease causes pancreatitis. Treatment involves supportive measures and pregnancy interruption. In this report, we describe a case of a previously healthy 26-year-old woman at a gestational age of 27 wk and 6 d who was admitted with severe abdominal pain and vomiting. This case illustrates the clinical and laboratory overlap between acute fatty liver of pregnancy and pancreatitis, highlighting the difficulties in differentiating each disease. Furthermore, the hypothesis for this overlapping is presented, and the therapeutic options are discussed.

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Acute fatty liver of pregnancy (AFLP) – an overview

Cited by 67 publications

References 21 publications

Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study

Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study

Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy

Acute fatty liver of pregnancy associated with severe acute pancreatitis: A case report

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