Patient's question:
My partner has fatty liver disease. They are quite overweight. We've been married for 4 years, and it's time to think about having children... I have a question: what are the symptoms of acute fatty liver during pregnancy? I want to be able to report them in a timely manner.Doctor's answer:
Hello, Acute Fatty Liver of Pregnancy (AFLP), also known as Obstetric Acute Pseudo-Johnson's Cholangiolitis, Idiopathic Fatty Liver of Pregnancy, and Liver Steatosis during Pregnancy, is a rare and fatal late-pregnancy disorder. It typically manifests acutely with rapid changes in clinical status, occurring between weeks 28 and 40 of gestation. It is more common in nulliparous women around 35 weeks of gestation, as well as in those with pregnancy-induced hypertension, twins, and male fetuses.Clinical Advice: AFLP is characterized by rapid onset and severe progression, with clinical manifestations similar to fulminant hepatitis. Historical literature reports maternal and fetal mortality rates of 75% and 85%, respectively. However, early diagnosis, prompt treatment, and timely delivery can reduce maternal mortality and lower infant mortality to 58.3%.
In the early stages, symptoms may include persistent nausea, vomiting, fatigue, upper abdominal pain, or headache. Jaundice typically appears within days to a week and progressively worsens, often without pruritus. Abdominal pain may be localized to the right upper quadrant or diffuse. Hypertension, proteinuria, and edema are common, while transient polyuria and polydipsia occur in some cases. If delivery does not occur, the condition may progress to coagulation dysfunction (e.g., petechiae, ecchymosis, gastrointestinal bleeding, gum bleeding), hypoglycemia, altered mental status, psychiatric symptoms, hepatic encephalopathy, oliguria, anuria, and renal failure, often leading to rapid death.