Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases☆,☆☆,★
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
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Cited by (0)
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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
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Reprint requests: Mary-Ames Castro, MD, Founders 430, Massachusetts General Hospital, Boston, MA 02114.
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0002-9378/99 $8.00 + 06/1/98351