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Introduction: Acute fatty liver of pregnancy remains an elusive and potentially fatal complication of a rare liver disease in late pregnancy. Due to sparse research, diagnostic dilemmas, and multi-organ involvement of the disease, it is imperative to elaborate the evaluation and management principles to confine the outcomes. Case Reports: Here, we aim to discuss in detail the peripartum manifestations and goal-directed management protocols in a case series of four patients managed at a tertiary care setup in India. Conclusion: It was found that all four cases had varied presentations ranging from asymptomatic hypoglycemia to liver failure and multiorgan dysfunction requiring a multidisciplinary perioperative care approach to prevent complications by incorporating supportive care along with latest available point of care diagnostics, interventional care, Extracorporeal Membrane Oxygenation (ECMO) and Continuous renal replacement therapy (CRRT).

From 2019 to 2021, 241 women in the UK died during pregnancy or in the 6-week period postpartum, as a direct or indirect result of the pregnancy, a mortality rate of almost 1 in 10,000. In 14% of cases, care was considered 'good', but in 52%, opportunities to improve care were identified that might have altered the outcome in a positive way. The admission rate to intensive care units for women who are pregnant or within the first six postnatal weeks exceeds 1 in 500 maternities, and is more common among women of black ethnic origin, older age, or those with severe obesity. Reasons for admission range from provision of close observation with or without invasive monitoring, to multi-organ support including extracorporeal therapies. An understanding of the types of organ support available, along with their indications and objectives, is important for all medical professionals caring for such women. This review describes the range of critical care organ support modalities available and how the physiology of pregnancy influences their use. The non-clinical challenges faced by professionals caring for these women who are critically unwell, from logistical to psychological, are also discussed. [ABSTRACT FROM AUTHOR]

IntroductionAcute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.MethodsWe searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.ResultsPooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I2 = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).DiscussionDespite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.

Abstract Background Acute fatty liver of pregnancy (AFLP) is an uncommon but potentially life-threatening complication. Lacking of prognostic factors and models renders prediction of outcomes difficult. This study aims to explore factors and develop a prognostic model to predict three-month mortality of AFLP. Methods This retrospective study included 78 consecutive patients fulfilling both clinical and laboratory criteria and Swansea criteria for diagnosis of AFLP. Univariate and multivariate cox regression analyses were used to identify predictive factors of mortality. Predictive efficacy of prognostic index for AFLP (PI-AFLP) was compared with the other four liver disease models using receiver operating characteristic (ROC) curve. Results AFLP-related three-month mortality of two medical centers was 14.10% (11/78). International normalised ratio (INR, hazard ratio [HR] = 3.446; 95% confidence interval [CI], 1.324–8.970), total bilirubin (TBIL, HR = 1.005; 95% CI, 1.000-1.010), creatine (Scr, HR = 1.007; 95% CI, 1.001–1.013), low platelet (PLT, HR = 0.964; 95% CI, 0.931–0.997) at 72 h postpartum were confirmed as significant predictors of mortality. Artificial liver support (ALS, HR = 0.123; 95% CI, 0.012–1.254) was confirmed as an effective measure to improve severe patients’ prognosis. Predictive accuracy of PI-AFLP was 0.874. Area under the receiver operating characteristic curves (AUCs) of liver disease models for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) and pregnancy-specific liver disease (PSLD) were 0.781, 0.774, 0.744 and 0.643, respectively. Conclusion TBIL, INR, Scr and PLT at 72 h postpartum are significant predictors of three-month mortality in AFLP patients. ALS is an effective measure to improve severe patients’ prognosis. PI-AFLP calculated by TBIL, INR, Scr, PLT and ALS was a sensitive and specific model to predict mortality of AFLP.

Objectives: To investigate whether platelet counts are associated with clinical outcomes in patients with acute fatty liver of pregnancy (AFLP). Methods: We retrospectively analyzed 140 patients with AFLP admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2010 and August 2022. In this cohort study, we used smooth curve fitting, Kaplan–Meier analysis, and multivariable logistic regression analysis to examine the independent relationship between platelet counts and 42‐day postpartum mortality in AFLP. Results: There were 140 patients with AFLP, of which 15 died and 53 (37.86%) had thrombocytopenia. The overall 42‐day postpartum maternal mortality was 10.7%. We observed a U‐shaped relationship between the platelet counts and 42‐day postpartum mortality. Two different slopes were observed below and above the inflection point at approximately 220 × 109/L. After adjusting for some confounders, patients with thrombocytopenia (<100 × 109/L) were found to have increased 42‐day postpartum mortality compared with middle‐tertile and highest‐tertile patients. Patients with thrombocytopenia had a higher 42‐day postpartum mortality, and higher proportions of intensive care unit admissions, postpartum hemorrhage, and multiple organ failure (P < 0.05). Conclusions: A U‐shaped association between platelet counts and 42‐day postpartum mortality was observed in patients with AFLP. Thrombocytopenia is associated with poorer adverse clinical outcomes in women with AFLP. Synopsis: Platelet counts and postpartum 42‐day mortality showed U‐shaped relationship in AFLP. Thrombocytopenia is associated with worse adverse clinical outcomes in pregnant women with AFLP. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy is a rare and critical disease in obstetrics, mainly characterized by liver failure, severe coagulopathy and other clinical manifestations, with rapid progression and high mortality. This article discusses the epidemic characteristics, pathogenesis, clinical manifestations, laboratory examination, clinical diagnosis and treatment of acute fatty liver during pregnancy. This paper summarizes the related contents of perioperative anesthesia in anesthesia methods, drug selection, coagulation regulation, organ protection and postpartum disease outcome.

Acute fatty liver of pregnancy (AFLP) is a rare but severe condition associated with high rates of maternal and foetal morbidity and mortality. Timely discontinuation of pregnancy, professional supervision and appropriate management are helpful for a successful discharge. This article reports the presentation and nursing care of a pregnant woman who was diagnosed with AFLP and discharged from the intensive care unit (ICU) after a prolonged hospitalization. The patient was admitted to the ICU on the first day after a caesarean section, with deterioration of liver, kidney and coagulation function. On day 1 of ICU admission, she underwent transnasal high‐flow oxygen therapy. Owing to worsening respiratory status and oxygen saturation <85%, the patient was intubated on day 3 in the ICU. Her urine output decreased significantly, her bilirubin level progressively increased, and she was treated with bilirubin adsorption and haemodialysis. Multiple organ dysfunction syndrome occurred, along with many other complications, including subarachnoid haemorrhage and lower extremity venous thrombosis. The patient was finally extubated on day 7, and haemodialysis was discontinued on day 42, with a daily urine output of approximately 2000 mL. The patient was discharged from the ICU 43 days after admission. Treatment and care activities under qualified nursing care, including managing haemorrhage and anticoagulation in haemodialysis, pain care based on psychological support, early rehabilitation and nutrition and providing appropriate care for respiratory support, contributed to the successful discharge of the patient from the ICU. During the patient's 43‐day stay in the ICU, strict monitoring and personalized nursing care were implemented. [ABSTRACT FROM AUTHOR]

This review article provides a comprehensive overview of common medical emergencies that can occur in pregnant patients. We summarize the key diagnostic and management steps for each emergency to assist health care professionals in identifying and treating these potentially life-threatening conditions. The medical emergencies discussed in this article include postpartum hemorrhage: hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; acute fatty liver of pregnancy: amniotic fluid embolism: pulmonary embolism; acute respiratory distress syndrome, and shock. Each condition is described in detail, with a focus on the clinical presentation, diagnostic workup, and treatment options. The information presented in this review article is based on current best practices and guidelines from leading medical organizations. We hope this article will serve as a valuable resource for health care professionals who care for pregnant patients and help improve outcomes for these patients in emergency situations. [ABSTRACT FROM AUTHOR]

Abstract Background To assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE). Methods We retrospectively reviewed the AFLP patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University and Xijing Hospital of Air Force Medical University from January 2012 to May 2022. Final prediction model for death among AFLP by means of stepwise backward elimination with p value

In the recent decades, endothelial dysfunction (ED) has been recognized as a significant contributing factor in the pathogenesis of many pathological conditions. In interaction with atherosclerosis, hypercholesterolemia, and hypertension, ED plays a crucial role in the pathogenesis of coronary artery disease, chronic renal disease, and microvascular complications in diabetes mellitus. Although ED plays a significant role in the pathogenesis of several pregnancy-related disorders such as preeclampsia, HELLP syndrome, fetal growth restriction, and gestational diabetes mellitus, the exact pathogenetic mechanisms are still a matter of debate. The increased prevalence of these entities in patients with preexisting vascular diseases highlights the essential pathological role of the preexisting ED in these patients. The abnormal uteroplacental circulation and the release of soluble factors from the ischemic placenta into the maternal bloodstream are the main causes of the maternal ED underlying the characteristic preeclamptic phenotype. Besides the increased risk for maternal and fetal poor outcomes, the preexisting ED also increases the risk of development of future cardiovascular diseases in these patients. This study aimed to look deeper into the role of ED in the pathogenesis of several pregnancy-related hypertensive and liver diseases. Hopefully, it could contribute to improvement of the awareness, knowledge, and management of these conditions and also to the reduction of the adverse outcomes and additional long-term cardiovascular complications. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We present the case of a rare obstetric emergency, which is usually fatal. Our case highlights suspicion of AFLP in patients presenting with jaundice in the third trimester with good maternal and fetal outcomes after a timely intervention. Acute fatty liver of pregnancy (AFLP) is a rare, obstetric emergency characterized by maternal liver dysfunction that can lead to maternal and fetal complications. We report a case of 28‐year‐old primigravida 39 weeks gestation diagnosed with AFLP complicated by coagulopathy with good maternal and fetal outcomes after a timely intervention. [ABSTRACT FROM AUTHOR]

Background: To assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE). Methods: We retrospectively reviewed the AFLP patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University and Xijing Hospital of Air Force Medical University from January 2012 to May 2022. Final prediction model for death among AFLP by means of stepwise backward elimination with p value < 0.05. Patients treated with and without PE were compared by propensity-matched cohort study. Results: Two hundred ninety eight patients with the diagnosis of AFLP, and finally 290 patients were enrolled in the cohort study, 50 of whom (17.2%) were dead. Compared with AFLP patients alive, the dead of patients were more likely to be combined encephalopathy (p < 0.01), postpartum hemorrhage (p < 0.01), and found significantly higher frequency of fetal distress (p = 0.04), fetal death (p < 0.01). we developed a predicted probability value and with an area under the receiver operating characteristics (ROC) curve of 0.94 (95%CI 0.87 to 1.00), indicating AFLP patients' death. The patients treated with PE had a significantly lower 60-day mortality rate (OR 0.42, 95% CI 0.29 to 2.64, p = 0.04), and significantly shorter duration of hospital-free days at day 28 (p = 0.01). Conclusions: In conclusion, our study indicated that liver function were risk factors for maternal mortality, and PE was a protective factor for maternal 60-day mortality and hospital-free days at day 28 in AFLP patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message We present the case of a rare obstetric emergency, which is usually fatal. Our case highlights suspicion of AFLP in patients presenting with jaundice in the third trimester with good maternal and fetal outcomes after a timely intervention. Abstract Acute fatty liver of pregnancy (AFLP) is a rare, obstetric emergency characterized by maternal liver dysfunction that can lead to maternal and fetal complications. We report a case of 28‐year‐old primigravida 39 weeks gestation diagnosed with AFLP complicated by coagulopathy with good maternal and fetal outcomes after a timely intervention.

Background: Acute fatty liver of pregnancy is rare and potentially lethal, occurring mainly in the third trimester of pregnancy, and can also occur in the immediate postpartum period, with a prevalence of 1 in every 16,000 pregnancies. It mainly occurs in primigravida women and is associated with preeclampsia, male newborn, multiple pregnancies, BMI < 20, and maternal obesity. The signs and symptoms are nonspecific and can progress to severe cases, even leading to maternal and fetal death. Diagnosis is based on Swansea criteria. The only effective treatment is delivery, and supportive treatment is essential. Aim: To report a case of acute fatty liver of pregnancy treated in our service. Case report: Patient a 28-year-old primigravida with untreated gestational diabetes mellitus, at term gestational age, presenting with lower abdominal pain, decreased fetal movement, and fetal bradycardia. A cesarean section was performed, and premature placental abruption was observed. The patient developed hypoglycemia, poor general condition, coagulopathy, and jaundice. The patient developed hepatic encephalopathy, which was reversed. After 19 days of hospitalization, she showed clinical improvement, was discharged, and followed up with a multidisciplinary team. Conclusion: Acute fatty liver of pregnancy (AFLP) is pregnancy-exclusive pathology, associated with a potentially fatal clinical course that can lead to multiple organ failure. Regardless of the timing of occurrence, AFLP presents with a similar and indistinguishable presentation. The only consideration that must be taken into account is the appropriate treatment for each period, always considering that delivery is the only treatment that establishes a cure. [ABSTRACT FROM AUTHOR]

To review the presenting signs, symptoms, laboratory findings, clinical courses, complications, and maternal outcomes in women determined on medicolegal review to have had acute fatty liver of pregnancy (AFLP). We retrospectively studied case files from women with medical and/or hypertensive complications of pregnancy which had been reviewed by the first author, deidentified and divested of legal documents so that only medical-related information was retained for later research and teaching purposes. Main outcomes are 12 lessons learned from this review to be offered for the future benefit of clinicians encountering patients with AFLP. Eleven women with AFLP were identified within the 161 file database. Signs and symptoms present in 91–100% of women with AFLP were altered sensorium, a fast resting maternal pulse >100/min, gastrointestinal complaints, muscle pain and evidence of fetal compromise/stillbirth. Laboratory findings in 91–100% revealed abnormal liver, renal and coagulation tests, hyperuricemia, and very low serum glucose and albumin. A correct initial diagnosis of AFLP was made for only three women; the most common incorrect presumptive diagnosis was HELLP syndrome. Four women survived. Twelve major findings are discussed. Rapid, timely and thorough evaluation of third trimester women presenting with A (Altered mental status changes/extreme sleepiness), F (Fast resting pulse >100 in the absence of fever or heart causation), L (Liver-related gastrointestinal complaints) and P (Pain as myalgias and body aches), often in association with evidence of fetal compromise or stillbirth, should initiate efforts to investigate a possible diagnosis of AFLP. Adoption of the concepts summarized including core initial laboratory testing, immediate patient transfer to tertiary care, and aggressive correction of consumptive coagulopathy could form the basis of a patient safety bundle to guide future management for patients with AFLP. [ABSTRACT FROM AUTHOR]

Introduction: Acute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients., Methods: We searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis., Results: Pooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I 2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I 2  = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22)., Discussion: Despite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42022315698., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Siwatch, De, Kaur, Lamba, Kaur, Singh and Periyasamy.)

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Abstract Background Acute fatty liver of pregnancy (AFLP) is an acute, rare and potentially lethal disease typically occurring in the third trimester of pregnancy. So far, there is no effective means of prevention. Therefore, in this study, we retrospectively analyzed the clinical features of AFLP patients for a better understanding. Meanwhile, for the first time, the genetic background associated with the onset of AFLP was discussed by high-throughput sequencing, hoping to provide evidence for genetic counseling and prenatal diagnosis of AFLP. Methods Thirteen AFLP patients admitted to our hospital and other hospital from March 2012 to February 2020 were selected. Clinical data about general condition, laboratory test, liver biopsy and the prognosis of mother and fetus were collected for retrospective analysis. In addition, the peripheral blood of five patients with AFLP and one newborn infant of his mother with AFLP was sequenced with whole-exome sequencing and gene mutation was analyzed by bioinformatics methods. Results The initial symptoms of AFLP varied differently, with jaundice (9/13, 69%), fatigue (8/13, 62%) and nausea and vomiting (6/13, 46%) being the most common. Moreover, the main maternal complications were coagulopathy (13/13, 100%), followed by acute renal dysfunction (10/13, 77%). Raised serum bilirubin, transaminases and uric acid were found in all patients (100%), hypoglycemia was found in six patients (46%) and fatty liver on ultrasound was seen in five patients (5/12, 42%). One (7%) maternal death occurred and all neonates survived delivery. In addition, to our surprise, whole-exome sequencing showed that no gene mutation in related enzymes involved in fatty acid metabolism was noted in the pregnant women and children receiving genetic testing. Conclusions Early visit, early detection, early termination of pregnancy and multidisciplinary comprehensive treatment are the key factors to improve the prognosis of AFLP patients and their newborn infants. Furthermore, although limited size of study, to our knowledge, this report is the first to present the lack of common mutation involved in fatty acid oxidation in Chinese patients with AFLP via whole-exome sequencing. Thus, further studies are needed with larger and more varied samples to validate the conclusion.

Objective: Rare disease Background: Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency that most commonly occurs in the third trimester and has high mortality rates for the mother and fetus. AFLP is a diagnosis of exclusion supported by identifying 6 or more of the 15 Swansea criteria. This report is of a 24-year-old woman presenting in the third trimester of pregnancy with nausea, vomiting, and abdominal pain and diagnosed with AFLP. Case Report: A 24-year-old woman presented at 36 weeks of gestation with nausea, vomiting, and abdominal pain. Investigations showed leukocytosis, hyperbilirubinemia, increased liver enzymes, hypoglycemia, hyperuricemia, acute kidney injury (AKI), and coagulopathy. Ten of the 15 Swansea criteria were fulfilled. An emergency cesarean section resulted in the delivery of a healthy infant, followed by a normalization of the mother's liver function. Because long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the infant can be associated with maternal AFLP, genotyping of the infant was planned. Conclusions: This report has shown the importance of clinical awareness, rapid diagnosis, and management of AFLP. Screening for fetal LCHAD deficiency could help decrease mortality. [ABSTRACT FROM AUTHOR]

Introduction: Acute fatty liver of pregnancy (AFLP) has been noticed due to high mortality rate for mother and fetus. However, the cause and pathogenesis of AFLP are unclear, and the absence of specific symptoms precludes early diagnosis and effective treatment. Therefore, this study was performed with aim to investigate the pregnancy outcomes in patients with acute fatty liver of pregnancy. Methods: This cross-sectional descriptive study was performed in 2013-2018. A total of 1475 records of women suspected to acute fatty liver of pregnancy, HELLP syndrome, severe pre-eclampsia and Thrombotic Thrombocytopenic Purpura (TTP) who were hospitalized in the university hospitals of Mashhad were selected and evaluated. Chief complaints at admission, laboratory data and pregnancy outcomes were evaluated. Data were analyzed by SPSS software (version 23). Results: A total of 34 records with diagnosis of AFLP were included in this study. Nausea and vomiting (94.11%), abdominal pain (94.11%) and hypertension (52.94%) were three main complaints in these patients, respectively. Laboratory test showed an increase in bilirubin, liver enzymes, coagulation tests, creatinine and a decrease in albumin and platelet count. Mean gestational age at the time of pregnancy termination was 34.2±2.04 weeks. We found 5 cases of maternal and 4 cases of neonatal mortality. Mean recovery time was 6.03±2.53 days. Conclusion: AFLP is associated with maternal mortality and the complications like multi organ failure, Diseminated intravascular coagulation, preterm labor, postpartum hemorrhage, and neonatal mortality. Since in this study, the most common complications of patients with AFPL were nausea, vomiting and abdominal pain, it is recommended to evaluate all pregnant women in third trimester who refer with these symptoms for diagnosis of AFLP.

Abstract Background Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome. Methods This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were compared. We analyzed the categorical variables with Chi-square test or Fisher’s exact test and continuous variables with Student’s t test or Mann-Whitney U test. Subsequent logistic regression analyses adjusting by potential confounding factors with significant difference were analyzed. Results During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0 % versus 23.8 %) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7 % versus 13.8 %), acute kidney injury (61.9 % versus 15.0 %), disseminated intravascular coagulopathy (66.7 % versus 8.8 %), and sepsis (47.6 % versus 10.0 %) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1 % versus 33.3 %), neonatal respiratory distress syndrome (39.2 % versus 8.3 %) and neonatal sepsis (34.2 % versus 12.5 %) were noted in the HELLP syndrome group. Conclusions AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

We present the case of a postpartum woman presenting with acute dyspnoea and hypoxia. She was found to have liver enzyme derangement with evidence of synthetic dysfunction. Computed tomography of her chest showed ground-glass opacities. The causes of this phenomenon are discussed, including the difficulties in differentiating amniotic fluid embolism and acute fatty liver in pregnancy. Pulmonary fat embolism is also considered as a differential diagnosis. [ABSTRACT FROM AUTHOR]

The liver is one of the richest organs in mitochondria, serving as a hub for key metabolic pathways such as β-oxidation, the tricarboxylic acid (TCA) cycle, ketogenesis, respiratory activity, and adenosine triphosphate (ATP) synthesis, all of which provide metabolic energy for the entire body. Mitochondrial dysfunction has been linked to subcellular organelle dysfunction in liver diseases, particularly fatty liver disease. Acute fatty liver of pregnancy (AFLP) is a life-threatening liver disorder unique to pregnancy, which can result in serious maternal and fetal complications, including death. Pregnant mothers with this disease require early detection, prompt delivery, and supportive maternal care. AFLP was considered a mysterious illness and though its pathogenesis has not been fully elucidated, molecular research over the past two decades has linked AFLP to mitochondrial dysfunction and defects in fetal fatty-acid oxidation (FAO). Due to deficient placental and fetal FAO, harmful 3-hydroxy fatty acid metabolites accumulate in the maternal circulation, causing oxidative stress and microvesicular fatty infiltration of the liver, resulting in AFLP. In this review, we provide an overview of AFLP and mitochondrial FAO followed by discussion of how altered mitochondrial function plays an important role in the pathogenesis of AFLP. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are both associated with significant maternal and perinatal morbidity and mortality. Because of the overlap of several clinical and laboratory findings differentiation can sometimes be difficult. Both disorders have been of interest for more than 100 years, however they were not completely characterized until the early 1980s. It was not until the 1980s that AFLP and HELLP syndrome, and more specifically their clinical, laboratory, and pathologic findings, were further differentiated in the literature. More recently, the pathophysiologic mechanisms have been elucidated. In this review, we outline the similarities and differences in the clinical presentation, laboratory findings, maternal and perinatal outcomes, and clinical recovery for women diagnosed with these two syndromes. From our observations, we suggest that levels of fibrinogen, creatinine, cholesterol, and total bilirubin be used to assist with differentiating AFLP from HELLP syndrome upon admission in women presenting with either suspected disease. The rationale for identifying the specific conditions is that clinical consequences for recovery vary considerably. Specifically, AFLP is associated with significantly more hepatic and renal dysfunction as well as coagulopathy. Fortunately, both conditions can be managed with supportive measures with overall improved perinatal outcomes including morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Liver disorders associated with pregnancy are important medical disorders that carries grave prognosis and challenging for both obstetricians and hepatologists. It affects about 3% of pregnancies worldwide and about 3-5% pregnancies in India. It can present with various symptoms like yellowish discolouration of sclera, dark coloured urine, anorexia, nausea, vomiting, abdominal pain etc. The liver disorders unique to pregnancy includes-hyperemesis gravidarum, preeclampsia, eclampsia with liver dysfunction, HELLP syndrome, Intrahepatic Cholestasis of Pregnancy (IHCP) and acute fatty liver of pregnancy. Aim: This study aims to evaluate demographic variables, causes of liver dysfunction during pregnancy and foeto-maternal outcome of pregnancies complicated by jaundice and liver dysfunction. Materials and Methods: This was a retrospective hospital based observational study on the pregnant women admitted with jaundice or any liver disorders in department of Obstetrics and Gynaecology in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of one year from March 2018 to February 2019. The incidence of liver disorders in pregnancy, its causes, the foetal outcome in terms of preterm birth, stillbirth, Foetal Growth Restriction (FGR) and Intrauterine Foetal Death (IUFD), the maternal outcome in terms of mode of delivery, complications, need for ICU admissions and maternal mortality were evaluated. Descriptive statistics like percentage and mean calculation were used to interpret the data. Results: Out of 8264 obstetrics admissions, 126 had liver disorder in pregnancy, incidence being 1.52%. Total 87 (69%) cases were primigravida, 115 (91.3%) cases presented during 3rd trimester of pregnancy, 101 (80.1%) were unbooked for our institution. A total of 92 (73%) were referred to us. Preeclampsia, eclampsia, HELLP syndrome was the most common cause of liver dysfunction accounting for 46.8% followed by IHCP in 31 (24.6%) cases. Out of 126, 115 women admitted in labour, of which 75 (65.3%) delivered vaginally, 38 (33%) taken for caesarean section and 2 died undelivered. Nine cases were admitted in 1st trimester and two cases in 2nd trimester who did not turn up after discharge. Neonatal mortality was seen in 18 (15.6%). Conclusion: Liver dysfunction in pregnancy carries grave prognosis with high incidence of perinatal and maternal morbidity and mortality. This study emphasises the need for regular Antenatal Care (ANC), need to remain vigilant for preventable causes like haemolytic jaundice, early diagnosis, proper treatment and timely referral of liver disorders with pregnancy to prevent the complications and improve foetal and maternal outcome. [ABSTRACT FROM AUTHOR]

The present article reports clinical findings of two pregnant women diagnosed with acute fatty liver of pregnancy (AFLP); emphasizing the serious consequence of caesarean delivery and the need for careful consideration in the decision making process of mode of delivery. [ABSTRACT FROM AUTHOR]

The etiology of most cases of liver diseases in pregnancy can be diagnosed with a thorough history, physical examination, laboratory values, serology, and noninvasive imaging. However, atypical clinical and laboratory presentations of liver diseases/chemistries require a liver biopsy to render an accurate diagnosis in cases where the biopsy results affect the timing of delivery or impact choice of medical therapy. According to the American College of Gastroenterology, liver biopsy can be effectively and safely conducted in pregnant women. Conventional routes of performing a liver biopsy include the percutaneous, transjugular route, and surgical methods. Endoscopic ultrasound-guided liver biopsy is a recent technique that has not yet gained widespread adoption but can potentially serve as an alternative route for obtaining the liver sample. Adverse events associated with liver biopsy include abdominal pain and hemorrhage. Maternal and fetal outcomes are limited to increased risk of preterm birth and small for gestational age neonate. However, very few studies have formally evaluated the safety of liver biopsy in pregnant women. In this review, we present two successful cases of liver biopsy performed during pregnancy and summarize the most recent evidence regarding the safety and outcomes of the procedure in pregnancy to assist clinicians in their decision to perform a liver biopsy during pregnancy or postpone it until after delivery. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy (AFLP) is a rare disorder that typically develops in the third trimester. We successfully diagnosed and treated a case of AFLP that developed at 18 weeks' gestation. A 34‐year‐old woman—gravida 4, para 3—presented with continuous vomiting and abdominal pain and developed convulsive seizures and lost consciousness after transfusion therapy. Cerebral apoplexy was excluded by computed tomography of the brain. Blood tests revealed severe metabolic acidosis, coagulopathy, and leukocytosis, followed by severe hypoglycemia and elevated levels of transaminases and ammonia. The fetus was delivered dead. Whole‐body computed tomography showed fatty liver. The patient was diagnosed with AFLP based on the Swansea criteria. AFLP may be a differential diagnosis in the second trimester, and rapid termination should be considered as radical treatment. Starvation may be a risk factor for this disorder. [ABSTRACT FROM AUTHOR]

Abstract Background Acute fatty liver of pregnancy (AFLP) is a potentially lethal condition of pregnant women with a high mortality rate. Potential predictors related to postpartum recovery time and prognostic factors of AFLP are still unclear. This study aimed to evaluate potential predictors for prognosis and postpartum recovery time of AFLP. Methods We retrospectively analyzed the clinical data of 76 AFLP patients in our hospital from 2002 to 2017 and investigated potential predictors using univariate analysis and multivariate logistic regression analysis. Results Hepatic encephalopathy (HE) was found to be associated with prognosis in AFLP patients (P = 0.005, OR = 26.844). The postpartum recovery time analysis showed that AFLP patients with a age

The article presents data on the features of hepatitis A, B, C, D, E in pregnant women, methods for screening verification of liver pathology, clinical and laboratory signs of extrahepatic manifestations of chronic viral hepatitis B and C. Diagnostically significant laboratory parameters of hemochromatosis, autoimmune hepatitis, intrahepatic cholestasis of pregnanсy, pernicious vomiting of pregnancy, acute fatty liver of pregnancy, HELLP syndrome were determined in the pre­sent work. The article describes modern methods for conduc­ting a laboratory “puncture-free” liver biopsy to evaluate fibrosis, hepatitis activity and liver steatosis. The lecture is intended for infectious disease doctors, obstetricians, gynecologists, gastroenterologists, family doctors.

Acute fatty liver of pregnancy (AFLP) is a rare catastrophic illness constituting an obstetric emergency in third trimester of pregnancy and may have complications for both mother and fetus, including death. Yet it is still unclear, the pathogenesis of AFLP has been identified related to defects in fatty acid metabolism during pregnancy, especially in the setting of fetal genetic defects in fatty oxidation. Establishing the diagnosis of AFLP is challenging, further it may overlap with other liver diseases of pregnancy, such as preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. The management of AFLP is a multidisciplinary progress providing the prompt intervention more than the termination of the pregnancy. The awareness of AFLP is highly needed to provide early diagnosis and management so that it can reduce the morbidity and mortality.

Abstract Background Limited data exists regarding the pregnancy and infant outcomes of Acute Fatty Liver of Pregnancy (AFLP). Methods Retrospectively collected mothers with AFLP and mothers without AFLP in our center from 1/2008 to 6/2018. The primary assessment was to analyze and compare the frequency of negative maternal and fetal outcomes. The secondary assessment was to investigate the role of intrauterine balloon tamponade in reducing negative maternal outcomes. Results Compared to 220 matched mothers, 55 AFLP mothers were younger (P

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening condition that develops in the third trimester of pregnancy. AFLP shares similar clinical features with other more common pregnancy-associated conditions. However, early correct diagnosis is important for maternal and fetal survival. Once the diagnosis has been established, immediate delivery and maternal intensive support should be undertaken. Both parents and the infant should be tested for deficiencies of the mitochondrial fatty acid oxidation, especially for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency, as many cases of AFLP are related to disruption of this physiological enzymatic pathway.

Abstract Background Early diagnosis is important to lower the mortality rate of acute fatty liver of pregnancy (AFLP). The Swansea criteria is commonly used to diagnose AFLP, but some terms could only be reached when symptoms and signs have progressed, or are not efficient in clinical practice. Therefore, it is necessary to select cost effective tests to simplify and facilitate early suspicion of acute fatty liver of pregnancy. Methods This is a retrospective study of 28,800 medical records at the Second Xiangya Hospital from 2009 to 2015, including 41 patients with AFLP and 172 other diseases that could show similar symptoms to AFLP. The evaluated variables included past history of liver diseases, blood pressure, gastrointestinal symptoms, blood count, liver function test, coagulation function test and blood sugar test. The sensitivity, specificity, positive predict value and negative predict value were calculated for models in diagnosing AFLP. Results The significant variables associated with AFLP included gastrointestinal symptoms, blood pressure > 140/90 mmHg, aminotransferase> 42 IU/l, total bilirubin> 0.8 mg/dl, total bilirubin acid> 10.0 μmol/L, activated partial prothrombin time(APTT) > 34 s, prothrombin time(PT) > 14 s, white blood cells> 11 *106/l and blood sugar

The case of acute fatty liver of pregnancy (rare pregnancy-related disorder) with favorable outcome has been reported. Diagnosis criteria, possible mechanisms of the disease, course and outcome have been discussed.

Acute Fatty Liver of Pregnancy (AFLP) is a rare and life-threatening obstetric emergency. Although the exact pathogenesis is unknown, the cases of AFLP are believed to be associated with abnormal fatty acid oxidation. The diagnosis of AFLP is a challenging task for the clinicians because of the nonspecific clinical presentation which may mimic conditions such as acute viral hepatitis, preeclampsia or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) syndrome. Early diagnosis, prompt obstetric management, intensive supportive care, and a multidisciplinary approach are the key to a good outcome. We here present two similar cases of AFLP with two different outcomes managed in a tertiary care center of the Andaman and Nicobar Islands.

Introduction: Liver disorders associated with pregnancy are important medical disorders that carries grave prognosis and challenging for both obstetricians and hepatologists. It affects about 3% of pregnancies worldwide and about 3-5% pregnancies in India. It can present with various symptoms like yellowish discolouration of sclera, dark coloured urine, anorexia, nausea, vomiting, abdominal pain etc. The liver disorders unique to pregnancy includes-hyperemesis gravidarum, preeclampsia, eclampsia with liver dysfunction, Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome, Intrahepatic Cholestasis of Pregnancy (IHCP) and acute fatty liver of pregnancy. Aim: To evaluate demographic variables, causes of liver dysfunction during pregnancy and foeto-maternal outcome of pregnancies complicated by jaundice and liver dysfunction. Materials and Methods: This was a retrospective hospital based observational study on the pregnant women admitted with jaundice or any liver disorders in Department of Obstetrics and Gynaecology in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, over a period of one year from March 2018 to February 2019. The incidence of liver disorders in pregnancy, its causes, the foetal outcome in terms of preterm birth, stillbirth, Foetal Growth Restriction (FGR) and Intrauterine Foetal Death (IUFD), the maternal outcome in terms of mode of delivery, complications, need for Intensive Care Unit admissions and maternal mortality were evaluated. Descriptive statistics like percentage and mean calculation were used to interpret the data. Results: Out of 8264 obstetrics admissions, 126 had liver disorder in pregnancy, incidence being 1.52%. Total 87 (69%) cases were primigravida, 115 (91.3%) cases presented during 3rd trimester of pregnancy, 101 (80.1%) were unbooked for our institution. A total of 92 (73%) were referred to us. Preeclampsia, eclampsia, HELLP syndrome was the most common cause of liver dysfunction accounting for 46.8% followed by IHCP in 31 (24.6%) cases. Out of 126, 115 women admitted in labour, of which 75 (65.3%) delivered vaginally, 38 (33%) taken for caesarean section and two died undelivered. Nine cases were admitted in 1st trimester and two cases in second trimester who did not turn up after discharge. Neonatal mortality was seen in 18 (15.6%). Conclusion: Liver dysfunction in pregnancy carries grave prognosis with high incidence of perinatal and maternal morbidity and mortality. This study emphasises the need for regular Antenatal Care (ANC), need to remain vigilant for preventable causes like haemolytic jaundice, early diagnosis, proper treatment and timely referral of liver disorders with pregnancy to prevent the complications and improve foetal and maternal outcome.