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Revista Médica Sinergia

2023, Number 05

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Revista Médica Sinergia 2023; 8 (05)

Acute fatty liver of pregnancy

Sancho AM, Brenes HC, Vargas VN

Language: Spanish
References: 23
Page:
PDF size: 232.90 Kb.


ABSTRACT

Acute fatty liver of pregnancy (AFLP) represents a serious obstetric complication which generally occurs in the III trimester, it is characterized by hepatic failure due to fatty infiltration of the liver. Approximately 3% of all pregnant women suffer of some kind of hepatic pathology during their pregnancy; AFLP is one of the rarest presentations nonetheless one of the deadliest both for the mother and fetus. Although the physiopathology of this disorder remains largely unknown, new studies have shown maternal and fetal genetic mutations in the mitochondrial beta oxidation of long chain fatty acids that lead to accumulation of fatty acids metabolites, which results in the mother’s liver damage due to fatty infiltration. The differential diagnosis between liver diseases in pregnancy is a challenge, especially with HELLP syndrome and preeclampsia, which share various clinical similarities with AFLP. Therefore, it is crucial to use sensitive diagnostic tools, like the Swansea criteria, which aids in an early diagnosis. The survival rate has improved in the last 30 years attributable to higher clinical suspicion and an adequate inter-disciplinary approach with obstetricians, gastroenterologists, and anesthesiologists, reducing the deadliest complications. AFLP can cause liver failure accompanied with renal insufficiency, coagulopathies, hypoglycemia, encephalopathy and often with multiorgan failure, hence it requires a prompt delivery for its resolution.


REFERENCES

  1. Nelson DB, Schell R. Acute Fatty Liver of Pregnancy. Contemporary OB/GYN. [Internet] 2021 Jun [citado el 5 de enero 2023] ;66(6). Disponible en: https://www.contemporaryobgyn.net/view/acute-fatty-liver-of-pregnancy

  2. Donck M, Vercruysse Y, Alexis A, Rozenberg S, Blaiberg S. Acute fatty liver of pregnancy – A short review. Australian and New Zealand Journal of Obstetrics and Gynaecology. [Internet] 2021 [citado el 5 de enero 2023] ;61(2):183–7. Disponible en: https://doi.org/10.1111/ajo.13293

  3. Naoum EE, Leffert LR, Chitilian H V., Gray KJ, Bateman BT. Acute Fatty Liver of Pregnancy. The American Society of Anesthesiologists. [Internet] 2019 [citado el 5 de nero 2023] ;130:446–61. Disponible en: https://doi.org/10.1097/ALN.0000000000002597

  4. García-Romero CS, Guzman C, Cervantes A, Cerbón M. Liver disease in pregnancy: Medical aspects and their implications for mother and child. Annals of Hepatology. [Internet] 2019 [citado el 5 de enero 2023] ;18(4):553–62. Disponible en: https://doi.org/10.1016/j.aohep.2019.04.00

  5. Gavidia Nuñez R, Férnandez Álvarez MM, Birga Ugarte IG, Bravo García NR, Bernal Gamio CE. Hígado Graso Agudo delEmbarazo, una Patología Infradiagnosticada: A Propósito de un Caso. Rev Peru Investig Matern Perinat. [Internet] 2022 [citado el 5 de enero 2022];11(2):38–41. Disponible en: https://doi.org/10.33421/inmp.2022276

  6. Lim E, Mouyis M, MacKillop L. Liver diseases in pregnancy. Clinical Medicine, Journal of the Royal College of Physicians of London. [Internet] 2021[citado el 5 de enero 2023] ;21(5):E441–5. Disponible en: https://doi.org/10.7861/clinmed.2021-0497

  7. Casey LC, Fontana RJ, Aday A, Nelson DB, Rule JA, Gottfried M, et al. Acute Liver Failure (ALF) in Pregnancy: How Much Is Pregnancy Related? Hepatology. [Internet] 2020 [citado el 5 de enero 2023]; 72(4):1366–77. Disponible en: https://doi.org/10.1002/hep.31144

  8. Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge. Geburtshilfe und Frauenheilkunde. [Internet] 2020 [citado el 5 de enero 2023]; 80(5):499–507. Disponible en: https://doi.org/10.1055/a-1091-8630

  9. Torres Rodriguez KJ. ¿Qué hay en común entre el hígado graso agudo del embarazo y la preeclampsia? Subdiagnóstico clínico de alta mortalidad. Revista Med. [Internet] 2019 [citado el 5 de enero 2023]; 27(1):61–72. Disponible en: https://doi.org/10.18359/rmed.2945

  10. Ramanathan R, Ibdah JA. Mitochondrial Dysfunction and Acute Fatty Liver of Pregnancy. International Journal of Molecular Sciences. [Internet] 2022 [citado el 5 de enero 2023]; 23(7):1–14. Disponible en: https://doi.org/10.3390/ijms23073595

  11. Ma K, Berger D, Reau N. Liver Diseases During Pregnancy. Clinics in Liver Disease. [Internet] 2019 [citado el 5 de enero 2023] ;23(2):345–61. Disponible en: https://dx.doi.org/10.18565/aig.2022.11.14-22

  12. Fallatah HI, Al-Dabbagh AA, Mimish HL, Al-Sahafi MA, Akbar HO. Liver diseases in pregnancy and outcomes: A retrospective study from Saudi Arabia. African Journal ofReproductive Health. [Internet] 2021 [citado el 5 de enero 2023]; 25(3):121–9. Disponible en: https://ucc.idm.oclc.org/login?URL=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=151253834&site=ehost-live

  13. Azzaroli F, Mazzella G, Marchesini G, Brodosi L, Petroni ML. Fatty liver in pregnancy: a narrative review of two distinct conditions. Expert Review of Gastroenterology and Hepatology. [Internet] 2020 [citado el 5 de enero 2023]; 14(2):127–35. Disponible en: https://doi.org/10.1080/17474124.2020.1715210

  14. Brady CW. Liver Disease in Pregnancy: What’s New. Hepatology Communications. [Internet] 2020 [citado el 5 de enero] ; 4(2):145–56. PubMed PMID: 32025601; PubMed Central; PMCID: PMC6996303. Disponible en: https://doi.org/10.1002/hep4.1470 .

  15. Ziki E, Bopoto S, Madziyire MG, Madziwa D. Acute fatty liver of pregnancy: A case report. BMC Pregnancy Childbirth. [Internet] 2019 [citado el 5 de enero 2023] ;19(1):5–7. Disponible en: https://doi.org/10.1186/s12884-019-2405-5

  16. Zhong Y, Zhu F, Ding Y. Early diagnostic test for acute fatty liver of pregnancy: A retrospective case control study. BMC Pregnancy and Childbirth. [Internet] 2020 [citado el 5 de enero 2023] ;20(1):1–6. Disponible en: https://doi.org/10.1186/s12884-020-2787-4

  17. Guarino M, Cossiga V, Morisco F. The interpretation of liver function tests in pregnancy. Best Practice and Research: Clinical Gastroenterology. [Internet] 2020 [citado el 5 de enero 2023] ;44–45(January):101667. Disponible en: https://doi.org/10.1016/j.bpg.2020.101667

  18. Afridi F, Feely M, Reddy R. Acute Fatty Liver Disease of Pregnancy in the Second Trimester. Case Reports in Critical Care. [Internet] 2020 [citado el 5 de enero 2023];1–5. Disponible en: https://doi.org/10.1155/2020/6705784

  19. Tran TT, Ahn J, Reau NS. ACG Clinical Guideline: Liver Disease and Pregnancy. American Journal of Gastroenterology. [Internet] 2016 [citado el 5 de enero 2023] ;111(2):176–94. Disponible en: https://journals.lww.com/ajg/Fulltext/2016/02000/ACG_Clinical_Guideline__Liver_Disease_and.15.aspx

  20. Ademiluyi A, Amakye DO, Jackson N, Betty S. Acute fatty liver of pregnancy. American Journal of Case Reports. [Internet] 2021 [citado el 5 de enero 2023] ;22(1):20–3. Disponible en: https://amjcaserep.com/abstract/full/idArt/933252

  21. Mazzola A, Magro B, Perdigao F, Charlotte F, Atif M, Goumard C, et al. Acute liver failure and HELLP syndrome: A clinical case and literature review. Clinics and Research in Hepatology and Gastroenterology. [Internet] 2021 [citado el 5 de enero 2023] ;45(2). PubMed PMID: 32828747 Disponible en: https://doi.org/10.1016/j.clinre.2020.07.00

  22. Qayed E. Chapter 4, Liver disease in pregnancy. In: Gastroenterology clinical focus: High Yield GI and Hepatology Review for Boards and Practice. Third. 2022. p. 70–1.

  23. Chang, L., Wang, M., Liu, H. et al. Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study. BMC Pregnancy Childbirth [Internet]. 2020 [citado el 5 de enero 2023]. 282 (2020). Disponible en: https://doi.org/10.1186/s12884-020-02980-2




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