rare but life-threatening condition that develops in the third trimester, particularly in patients with multiple gestation.
intrinsic intrahepatic process due to microvesicular fatty infiltration of hepatocytes secondary to abnormal maternal-fetal fatty acid metabolism
hepatic inflammation (eg, epigastric/right upper quadrant pain, leukocytosis, elevated aminotransferases) and subsequent fulminant liver failure (eg, scleral icterus, hyperbilirubinemia, profound hypoglycemia). As AFLP progresses, patients can develop multiorgan system failure, including disseminated intravascular coagulopathy (eg, hemolytic anemia, thrombocytopenia) and acute kidney injury (from hepatorenal syndrome).
MILDLY elevated aminotransferases. However acute-onset fulminant liver failure that manifests as profound hypoglycemia (from inability to convert glycogen to glucose), hyperbilirubinemia, thrombocytopenia(<100,000/mm³), and possible disseminated intravascular coagulopathy.
As the mother decompensates, the placenta hypoperfuses, which can result in fetal hypoxemia, acidosis, and subsequent death. Due to high maternal and fetal mortality rates, management of AFLP is with maternal stabilization and immediate delivery, regardless of gestational age.
<aside> 💡 It is not typically associated with proteinuria nor hypertension to differentiate from PET with severe features
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| Clinical features | • Nausea, vomiting • Right upper quadrant/epigastric pain • Fulminant liver failure | | --- | --- | | Laboratory findings | • Profound hypoglycemia • ↑ Aminotransferases (2-3× normal) = mild • ↑ Bilirubin • Thrombocytopenia • Disseminated intravascular coagulopathy | | Management | • Immediate delivery |
LABs example
the source of elevated alkaline phosphatase level is likely the placenta.
(Choices D and E) MRI and ultrasound are preferred imaging modalities in pregnancy due to low risk of fetal radiation exposure; they are performed in patients with an uncertain diagnosis. Neither is required to diagnose AFLP, and delaying delivery increases fetal and maternal mortality. Liver biopsy is not needed for the diagnosis of AFLP and increases this patient's bleeding risk due to thrombocytopenia and possible coagulopathy from liver dysfunction.