Clinical

Fatty liver of pregnancy generally resolves quickly

Last Updated: 2013-08-09 19:00:16 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Women with acute fatty liver of pregnancy (AFLP) show varying degrees of clinical and laboratory derangements, but most recover relatively swiftly, a new analysis shows.

"The most prominent organ system derangements are hepatic dysfunction, renal insufficiency, and impaired procoagulant synthesis," Dr. David B. Nelson told Reuters Health by email. "Clinical recovery was observed in most women with AFLP within three to four days after delivery, although laboratory studies lagged in returning to normal."

Still, in these women, "It is imperative before delivery to assess the severity of coagulopathy to allow planning to restore fibrinogen and other procoagulants to clinically functional levels with fresh frozen plasma, cryoprecipitate, or whole blood if operative delivery is necessitated," he and his colleagues wrote in a paper online July 13th in the American Journal of Obstetrics & Gynecology.

Dr. Nelson of the University of Texas Southwestern Medical Center at Dallas and colleagues note that fatty liver of pregnancy is rare now. It was often prompted by use of chloroform and tetracycline. When their use declined in obstetrics, so did the incidence of the disease.

Today, estimates of the frequency of AFLP range from 1 per 7,000 to 1 per 20,000 births, the researchers say. To gain more information, they examined data on 51 women who developed AFLP between 1975 and 2012. The frequency was 1 per 10,000.

The clinical presentation was variable and largely dependent on the severity of liver dysfunction. The most common complaints were persistent nausea and vomiting (57%), hypertension (57%), and abdominal pain (53%). More than 90% of the women had at least one of these complaints.

Hemorrhage from coagulopathy associated with liver failure was the most common complication. Procoagulant synthesis was impaired in more than three-fourths of the women. The cesarean delivery rate was nearly 50%, and more than 50% of the women overall required blood transfusions.

There were two deaths. One woman died of acute respiratory distress following aspiration of vomit and the other was died of fulminant liver failure with unsustainable hypotension.

Acute kidney injury was one of the predisposing factors, with at least 15% of the women having elevated creatinine values. Clinically, say the investigators, "recognition of acute kidney injury is important so that drugs with renal clearance are either avoided or given in attenuated doses."

Composite recovery times of various markers of hepatic and renal function showed that most laboratory values normalized within 7-10 days after delivery.

"Ongoing hepatocellular damage decreases soon after delivery, but the duration of recovery for total return of liver function depends upon overall disease severity," Dr. Nelson said.

SOURCE: http://bit.ly/1biinoz

Am J Obstet Gynecol 2013.