Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases,☆☆,

https://doi.org/10.1016/S0002-9378(99)70567-3Get rights and content

Abstract

Objective: We sought to describe our experience with the clinical diagnosis, management, and course of patients with acute fatty liver of pregnancy. Study Design: Twenty-eight cases of acute fatty liver of pregnancy at the Los Angeles County and University of Southern California Medical Center from 1982 to June 1997 were identified, and presenting symptoms, clinical course, laboratory values, maternal complications, and neonatal outcomes were studied. Results: The incidence of acute fatty liver of pregnancy was 1 in 6659 births. There were no maternal deaths. Initial presentation was at an average of 37 weeks of gestation with a characteristic prodrome of malaise, nausea, vomiting, and abdominal pain. No patient was admitted with the diagnosis of acute fatty liver of pregnancy. The condition was diagnosed most commonly on the second hospital day after laboratory results indicated coagulopathy, renal insufficiency, and liver function abnormalities. One patient underwent liver biopsy at cesarean delivery. Radiologic studies did not aid with the diagnosis. Twenty-one patients were admitted in spontaneous labor, and 16 labors were complicated by abnormal fetal heart rate patterns or meconium. There was 1 stillbirth and 1 neonatal death as a result of perinatal asphyxia. Maternal morbidity consisted of hypoglycemia, infection, renal insufficiency, coagulopathy, encephalopathy, and wound complications. All patients had evidence of disseminated intravascular coagulopathy with profoundly decreased antithrombin levels. All patients recovered normal liver function post partum. Conclusions: Reversible peripartum liver failure may be diagnosed and managed on the basis of clinical and laboratory criteria. With adequate support, these patients may have full recovery of hepatic function. (Am J Obstet Gynecol 1999;181:389-95.)

Section snippets

Methods

All cases of acute fatty liver of pregnancy diagnosed at the Los Angeles County and University of Southern California Medical Center from January 1982 to June 1997 were reviewed. The basis for the diagnosis of acute fatty liver of pregnancy was clinical and laboratory evidence of acute hepatic failure in the third trimester of pregnancy, with marked reduction in hepatic metabolic activity. Other causes of liver dysfunction, such as viral hepatitis, biliary tract disease, and cholestasis of

Results

Twenty-eight patients with the diagnosis of acute fatty liver of pregnancy were identified during the study period. There were 199,767 deliveries during this 15-year period, giving an incidence of 1 in 6659 births.

Comment

Acute fatty liver of pregnancy remains a serious disease despite the improved outcomes reported in this series. The large number of patients from 1 institution, cared for by a consistent multidisciplinary team of consultants, offers a new perspective and understanding of this disease.

The reported incidence of acute fatty liver of pregnancy has been increasing, a trend that continues with this article. Maternal and fetal mortality rates, however, have been decreasing. In the first series

References (25)

  • WJ Watson et al.

    Acute fatty liver of pregnancy

    Obstet Gynecol Surv

    (1990)
  • AJ Woolf et al.

    Acute liver failure in pregnancy: case report with survival of mother and child

    Br J Obstet Gynaecol

    (1964)
  • Cited by (0)

    From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital,a the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County and University of Southern California Women’s and Children’s Hospital,b the Division of Hepatology, Department of Medicine, Los Angeles County and University of Southern California Medical Center,c and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, White Memorial Medical Center, Los Angeles.d

    ☆☆

    Reprint requests: Mary-Ames Castro, MD, Founders 430, Massachusetts General Hospital, Boston, MA 02114.

    0002-9378/99 $8.00 + 06/1/98351

    View full text