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Chapter 41 - Acute Fatty Liver of Pregnancy

from Section 7 - Hepato-Renal and Gastrointestinal Conditions in Pregnancy

Published online by Cambridge University Press:  23 February 2023

By
Neel S. Iyer ,
Meena Khandelwal  and
Amira El-Messidi
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

During your call duty, a healthy 40-year-old primigravida with a spontaneous dichorionic pregnancy presents, accompanied by her husband, to the obstetric emergency assessment unit of your hospital center at 33+1 weeks’ gestation with new-onset abdominal pain and vomiting after a two-day history of nausea and general malaise. She has no obstetric complaints, and fetal viabilities are ascertained upon presentation. Her face appears yellow tinged relative to her last clinical visit one week ago. You recall that routine prenatal laboratory investigations, aneuploidy screening, morphology surveys of the male fetuses, and serial sonograms have all been unremarkable.

Keywords

Acute fatty liver of pregnancyPathogenesisRisk factorsClinical presentation, manifestationsPhysical examinationInvestigationsDifferential diagnosisSwansea criteria, diagnosisPerinatal risks, complications, maternal-fetal morbidity, adverse outcomeAntenatal, delivery managementNeonatal investigationsPostpartum counselingContraception
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 531 - 541
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

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. 2020;20(1):282.CrossRefGoogle ScholarPubMed
Donck, M, Vercruysse, Y, Alexis, A, et al. Acute fatty liver of pregnancy – a short review. Aust N Z J Obstet Gynaecol. 2021;61(2):183–187.Google Scholar
Guarino, M, Cossiga, V, Morisco, F. The interpretation of liver function tests in pregnancy. Best Pract Res Clin Gastroenterol. 2020;44–45:101667.CrossRefGoogle ScholarPubMed
Liu, J, Ghaziani, TT, Wolf, JL. Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. Am J Gastroenterol. 2017;112(6):838–846.CrossRefGoogle ScholarPubMed
Nelson, DB, Byrne, JJ, Cunningham, FG. Acute fatty liver of pregnancy. Clin Obstet Gynecol. 2020;63(1):152–164.Google Scholar
Nelson, DB, Byrne, JJ, Cunningham, FG. Acute fatty liver of pregnancy. Obstet Gynecol. 2021;137(3):535–546.Google Scholar
Nelson, DB, Yost, NP, Cunningham, FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol. 2013;209(5):456.e1–456.e4567.CrossRefGoogle ScholarPubMed
Naoum, EE, Leffert, LR, Chitilian, HV, et al. Acute fatty liver of pregnancy: pathophysiology, anesthetic implications, and obstetrical management. Anesthesiology. 2019;130(3):446–461.CrossRefGoogle ScholarPubMed
Rath, W, Tsikouras, P, Stelzl, P. HELLP syndrome or acute fatty liver of pregnancy: a differential diagnostic challenge: common features and differences. Geburtshilfe Frauenheilkd. 2020;80(5):499–507.Google Scholar
Tran, TT, Ahn, J, Reau, NS. acg clinical guideline: liver disease and pregnancy. Am J Gastroenterol. 2016;111(2):176–196. [Correction in Am J Gastroenterol. 2016 Nov;111(11):1668]CrossRefGoogle ScholarPubMed

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