Chapter 196 Acute Fatty Liver of Pregnancy
INTRODUCTION
Description: Acute fatty liver is a rare complication of pregnancy that results in acute liver failure, often with catastrophic consequences. It is also known as acute fatty metamorphosis or acute yellow atrophy.
ETIOLOGY AND PATHOGENESIS
Causes: Unknown (mimics other forms of fatty liver failure such as that induced by tetracycline in patients with impaired renal function, Reye’s syndrome, hepatotoxicity with sodium valproate, or salicylate intoxication). It is currently thought that the placenta of a fetus who is LCHAD deficient may produce a toxic metabolite that affects the maternal liver.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Gradual onset of malaise, anorexia, nausea and persistent vomiting, epigastric pain, and progressive jaundice
• Hypofibrinogenemia, prolonged clotting time, hyperbilirubinemia (<10 mg/dL), mild thrombocytopenia, hemolysis, markedly reduced antithrombin III levels, (severe coagulopathy in 55%), hypoglycemia.
