Archives of Gynecology and Obstetrics

, Volume 274, Issue 6, pp 349–353 | Cite as

Acute fatty liver of pregnancy

  • Khalid Mjahed
  • Boubker Charra
  • Driss Hamoudi
  • Mohamed Noun
  • Lhoucine Barrou
Original Article



Acute fatty liver of pregnancy (AFLP) is a rare and serious entity associated with significant maternal and neonatal mortality and morbidity. We describe our experience with the clinical diagnosis, management and course patients with AFLP.

Study design

Medical records of patients with AFLP were reviewed over a 10-year period. Records were reviewed for symptoms, laboratory findings, clinical course, and maternal and perinatal outcomes.


The incidence of AFLP was 1 in 7,270 births. The mean gestational age at onset was 34.6 ± 4.9 weeks. Eight percent of the patients were multiparous with more than three pregnancies. The prodromic phase was variable; patients complained of nausea, abdominal pain, malaise, polyuria-polydipsia syndrome and headaches followed by jaundice. The laboratory results indicated coagulopathy, liver function abnormalities and hypoglycemia. Emergency cesarean section was performed in two cases. The diagnosis has been assessed by transcutaneous hepatic biopsies processed in all patients between the 4th and 15th day (8.4 ± 4.3 days). Maternal morbidity included hypoglycaemia (40%), coagulopathy (50%) encephalopathy (30%) and renal failure (40%). There were no maternal deaths but fetal mortality is high 66%.


The early recognition of AFLP cases and prompt progressive management, including early termination of pregnancy and large dose infusion of fresh frozen plasma, the prognosis of AFLP is obviously improved.


Acute fatty liver Pregnancy Liver disease 


  1. 1.
    Sheehan HL (1940) The pathology of acute yellow atrophy and delayed chloroform poisoning. J Obstet Gynaecol 47:49–62Google Scholar
  2. 2.
    Castro MA, Fasett MJ, Reynolds TB, Shaw KJ, Goodwin TM (1999) Reversible peripartum liver failure: a new perspective on the diagnosis treatment, and cause of acute fatty liver of pregnancy based on 28 consecutive cases. Am J Obstet Gynecol 181:389–95PubMedCrossRefGoogle Scholar
  3. 3.
    Browning MF, Levy HL, Wilkins-Haug LE, Larson C, Shih VE (2006) Fetal fatty acid oxidation defects and maternal liver disease in pregnancy Obstet Gynecol 107:115–120PubMedGoogle Scholar
  4. 4.
    Jamerson PA (2005) The association between acute fatty liver of pregnancy and fatty acid oxidation disorders J Obstet Gynecol Neonatal Nurs 34:87–92CrossRefGoogle Scholar
  5. 5.
    Wetzka B, Hoffman MM, Friedrich I, Baumstark MW, Zahradnik HP, Marz W, Winkler K (2004) Transient remnant removal disease in acute fatty liver of pregnancy. Hypertens Pregnancy 23:143–153PubMedCrossRefGoogle Scholar
  6. 6.
    Reyes H, Sandoval L, Wainstein A, Ribalta J, Donoso S, Smok G, Rosenberg H, Meneses M (1994) Acute fatty liver of pregnancy: a clinical study 12 episodes in 11 patients. Gut 35:101–106PubMedCrossRefGoogle Scholar
  7. 7.
    Usta IM, Barton JR, Amen EA, Gonzalez A, Sibai BM (1994) Acute fatty liver of pregnancy: an experience in the diagnosis and management of fourteen cases. Am J Obstet Gynecol 171:1342–1347PubMedGoogle Scholar
  8. 8.
    Bourlière M, Bernuau J, Ducrotte S, Walch, Rueff B, Benhamou JP (1989) Polyuria and polydipsia in acute fatty liver of pregnancy. A case report. (In French). J Gynecol Obstet Biol Reprod 18:79–81Google Scholar
  9. 9.
    Vigil-DeGracia P (2001) Acute fatty liver and HELLP syndrome: two distinct pregnancy disorders. Int J Gynecol Obstet 73:215–220CrossRefGoogle Scholar
  10. 10.
    Castro MA, Ouzounian JG, Colletti PM, Shaw KJ, Stein SM, Goodwin TM (1996) Radiologic studies in acute fatty liver of pregnancy. A review of the literature and 19 new cases. J Reprod Med. 41:839–843PubMedGoogle Scholar
  11. 11.
    Goodlin RC (2000) Not all cases in a reported series were acute fatty liver of pregnancy. Am J Obstet Gynecol. 182:1650PubMedCrossRefGoogle Scholar
  12. 12.
    Vigil-De Gracia P, Lavergne JA (2001) Acute fatty liver of pregnancy. Int J Gynecol Obstet 72:193–195CrossRefGoogle Scholar
  13. 13.
    Hamid SS, Jafri SM, Khan H, Shah H, Abbas Z, Fields H (1996) Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis? J Hepatol 25:20–27PubMedCrossRefGoogle Scholar
  14. 14.
    Fesenmeier MF, Coppage KH, Lambers DS, Barton JR, Sibai BM (2005) Acute fatty liver of pregnancy in 3 tertiary care centers Am J Obstet Gynecol 192:1416–1419PubMedCrossRefGoogle Scholar
  15. 15.
    Ko H, Yoshida EM (2006) Acute fatty liver of pregnancy Can J Gastroenterol 20:25–30PubMedGoogle Scholar
  16. 16.
    Holzman RS, Riley LE, Aron E, Fetherston J (2001) Perioperative care of a patient with acute fatty liver of pregnancy. Anesth Analg 92:1268–1270PubMedCrossRefGoogle Scholar
  17. 17.
    Riely CA (1987) Acute fatty liver of pregnancy. Semin Liver Dis 7:47–54PubMedCrossRefGoogle Scholar
  18. 18.
    Moldenhauer JS, O’Brien JM, Barton JR, Sibai B (2004) Acute fatty liver of pregnancy associated pancreatitis: a life-threatening complication. Am J Obstet Gynecol 190:502–505PubMedCrossRefGoogle Scholar
  19. 19.
    Buytaert IM, Elewaut GP, Van Kets HE (1996) Early occurence of acute fatty liver of pregnancy. Am J Gastroenterol 91:603PubMedGoogle Scholar
  20. 20.
    Knox TA, Olans LB (1996) Liver disease in pregnancy. N Engl J Med 335:569–576PubMedCrossRefGoogle Scholar
  21. 21.
    Pereira SP, O’donohue J, Wendon J, Williams R (1997) Maternal and perinatal outcome in severe pregnancy-related liver disease Hepatology 26:1258–1262PubMedGoogle Scholar
  22. 22.
    Barton JR, Sibai BM, Mabie WC, Shanklin DR (1990) Recurrent acute fatty liver of pregnancy. Am J Obstet Gynecol 163:534–538PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Khalid Mjahed
    • 1
  • Boubker Charra
    • 1
  • Driss Hamoudi
    • 1
  • Mohamed Noun
    • 2
  • Lhoucine Barrou
    • 1
  1. 1.Department of Anaesthesia and Intensive CareIbn Rochd University HospitalCasablancaMorocco
  2. 2.Service de Gynécologie-ObstétriqueIbn Rochd University HospitalCasablancaMorocco

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