Acute Fatty Liver of Pregnancy Progressing to Acute Liver Failure Despite Delivery
Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening obstetric emergency. In a subset of affected women, hepatic impairment reaches a severe threshold and, in some cases, continues to deteriorate even after delivery has occurred.
Clinical scenario
This protocol applies to women with AFLP in whom severe hepatic impairment is established and who are at risk of progressing — or have already progressed — to acute liver failure despite delivery. Timely recognition of this escalating trajectory is critical to patient outcome.
Management approach
When severe hepatic impairment is present, management centres on early engagement of appropriate specialist services. For the small proportion of women whose condition continues to deteriorate despite delivery, a definitive hepatic intervention may be required. The complete pathway, eligibility criteria, and decision points are detailed in the structured protocol.
References
DOI: 10.1016/j.jhep.2023.03.006
- In the subset of women with acute fatty liver of pregnancy who have severe hepatic impairment and may require transplantation, early referral to a transplant centre should be made.
- A small proportion of women can progress to acute liver failure despite delivery, necessitating LT.