What Is the Treatment of Acute Fatty Liver of Pregnancy?
Clinical Scenario
Acute fatty liver of pregnancy (AFLP) is a rare, serious hepatic complication of the third trimester requiring urgent, coordinated management. Rapid diagnosis and prompt action are essential to reduce maternal and perinatal risk.
Management Approach
First-line management involves correcting critical metabolic derangements as the immediate priority, followed by expedited delivery — with the mode of delivery determined through multidisciplinary assessment. The complete sequence and decision framework are in the full protocol.
Treatment Goals
Success is measured by the normalisation of liver enzyme levels and prompt recovery of renal function in the postpartum period.
References
DOI: 10.1016/j.jhep.2023.03.006
- Delivery should be expedited once coagulopathy and remediable metabolic derangements have been treated, and decisions about mode of delivery should be made jointly by obstetricians, hepatologists and the multidisciplinary team.
- Current recommended practice is to ensure coagulopathy, hypoglycaemia and metabolic acidosis are stabilised/corrected and then to expedite delivery of the fetus in women diagnosed with AFLP antenatally.
- In AFLP, small observational studies found that caesarean section is associated with improved maternal and perinatal outcomes compared to vaginal delivery.
- Nonetheless, generally rapid delivery after stabilisation of hypoglycaemia, acid-base balance and coagulopathy is recommended.
- However, when fetal demise has occurred, expedited vaginal induction could be considered (instead of caesarean section).
- Hepatocellular necrosis was demonstrated to peak at the time of delivery and showed prompt recovery with reduction of liver transaminase measurements to <100 IU/L by the second or third day postpartum.
- In a similar fashion, recovery of renal function was prompt after delivery.
View source ↗