Acute Fatty Liver of Pregnancy: Clinical Features and Treatment Strategies in a Single-Center Study

Abstract

Acute Fatty Liver of Pregnancy (AFLP) is a rare but life-threatening complication of pregnancy that typically occurs in the third trimester. This study aimed to investigate the clinical and demographic features of patients with AFLP and evaluate the effectiveness of various treatment strategies. A total of five patients were diagnosed with AFLP between January 2020 and December 2022. The mean age of the patients was 28 years, with two patients having a history of diabetes, and two patients were COVID-19 positive. The mean gestational age at diagnosis was 31 weeks and 1 day, with two patients admitted for high blood pressure, one for sudden onset jaundice, and two for delivery. All patients met the Swansea criteria for AFLP diagnosis. Three patients developed neurological symptoms in the postpartum period, two with hypoglycemic coma due to liver failure and one with hepatic encephalopathy. Two patients had renal insufficiency, one with a hemorrhagic syndrome, and one with disseminated intravascular coagulation (DIC). All patients had thrombocytopenia, and two patients had a platelet count below 50,000. Obstetric ultrasound/doppler showed an evolving monofetal pregnancy in four cases and fetal demise in one case. Two patients were treated with therapeutic plasma exchange, and two underwent continuous renal replacement therapy until renal function normalized. The patient with a hemorrhagic syndrome received two units of platelets postpartum, while the patient with DIC received fresh frozen plasma. One patient had a vaginal delivery, while four patients had a cesarean section.