Patient's question:
Left and right.Doctor's answer:
AFLP typically occurs during the 28th to 40th week of pregnancy, with an average of the 36th week, and is most common in women aged 26 to 30. Approximately 48% of patients are first-time mothers, among whom 14% are carrying twins. The male-to-female ratio of infants is 3:1.AFLP has a rapid onset, with the main clinical manifestations including fatigue, anorexia, nausea, vomiting, abdominal pain, and a tendency toward bleeding, which can quickly progress to coma. About 90% of patients experience persistent nausea and vomiting, with abdominal pain primarily localized to the right upper abdomen or hypochondriac region. Within days of onset, as the condition progresses, progressive jaundice may develop, often appearing obstructive. Severe bleeding tendencies may lead to symptoms such as epistaxis, gingival bleeding, skin and mucosal bleeding, gastrointestinal bleeding, vaginal bleeding, and in severe cases, disseminated intravascular coagulation (DIC). Some patients may also experience headache, fever, diarrhea, and back pain. Physical examination reveals an acute appearance, progressive liver atrophy, ascites, rapidly worsening jaundice, fever, and varying degrees of altered consciousness. Severe cases may rapidly progress to coma or even death.
Medical Advice: AFLP patients often exhibit varying degrees of pregnancy edema, proteinuria, and hypertension, with about 50% developing renal failure. Severe cases may lead to miscarriage, stillbirth, or premature death within 7–12 days of onset. The rapid progression of AFLP makes shock, DIC, sepsis, liver failure, and renal failure leading causes of death or contributing factors.
### 4. Laboratory and Special Tests
#### 4.1 Complete Blood Count
White blood cell count increases to (20–30) × 10?/L, with an elevated neutrophil ratio. Anemia is normocytic, and platelet count is normal or decreased.
#### 4.2 Biochemical Tests
ALT and AST levels are significantly elevated, while γ-GT and ALP show mild to moderate increases. Total serum bilirubin is often greater than 171 μmol/L, primarily due to elevated conjugated bilirubin. Serum albumin decreases, and hypoglycemia occurs in about 25% of cases. Renal impairment is indicated by elevated blood urea nitrogen and creatinine levels. If pancreatitis is present, blood and urine amylase may rise.
#### 4.3 Ultrasound
Liver parenchyma shows increased echogenicity, appearing as "bright liver," with liver volume reduction. Sensitivity is lower than that of CT.
#### 4.4 CT Scan
Large areas of decreased liver density are observed, with CT values dropping to half the normal range.
#### 4.5 Liver Biopsy
Frozen sectioning and specific fat staining of liver biopsy tissue are important diagnostic methods for AFLP.
### 5. Diagnosis and Differential Diagnosis
Early diagnosis of AFLP is challenging and relies primarily on medical history, symptoms, physical examination, laboratory tests, and liver biopsy. AFLP should be differentiated from acute viral hepatitis, intrahepatic cholestasis, drug-induced liver disease, and preeclampsia.
### 6. Treatment
There is no specific therapy for AFLP. Once diagnosed, pregnancy should be terminated as soon as possible via cesarean delivery or induction, to improve prognosis. Supportive and symptomatic treatment should be provided. Nutrients can be supplemented via peripheral veins, with central venous nutrition reserved for necessity, to maintain fluid and electrolyte balance. Medications such as Gan-Tai-Le, Gan-De-Jian, methionine, and compound choline may be used in moderation. Patients with anemia or significant bleeding tendencies may receive red blood cell, platelet, or fresh frozen plasma transfusions. Ascites is treated with albumin, diuretics, and paracentesis. In cases of hepatic encephalopathy, protein intake should be restricted, and relevant medications administered, along with active treatment of DIC, pancreatitis, and gastrointestinal bleeding. Corticosteroids and immunomodulators may improve survival rates and can be used as needed. Liver transplantation is a new treatment option, but AFLP is a reversible condition, so careful consideration is required.