Second and third trimesters :
Acute Fatty Liver of Pregnancy :
Continued. .
Course and Management:
Patients with undiagnosed AFLP are at risk for progression.
With an unpredictable but often short time course, to fulminant hepatic failure and death for both mother and fetus.
Now it is rare for a patient to die, with appropriate diagnosis and aggressive management.
Similarly, the outlook for the fetus of the affected pregnancy has also improved, although it remains worse than that of the mother.
All patients should be hospitalized as soon as the diagnosis of AFLP is suspected.
Moderate or severely affected patients (encephalopathic, deeply jaundiced, with a prothrombin time less than 40% of the control), or with any extrahepatic complications, should be attended in intensive care units.
It seems convenient to maintain glucose infusions, because of the risk of a sudden hypoglycemia until a full metabolic recovery is obtained.
Treatment of AFLP begins with delivery.
The route should be guided by obstetric indications.
Cesarean section is not always necessary, vaginal delivery can be accomplished.
With delivery, repair of the liver disease begins, the initial sign of improvement being a fall in prothrombin time elevation.
The management should include maximal support in an intensive care unit by a team that includes both obstetricians and hepatologists.
Liver transplantation for AFLP has been reported.
There are no residua after AFLP, and complete recovery of the affected patient should be expected. Cases of recurrent AFLP, as well as cases of nonketotic hypoglycemia in the offspring, have been reported.
Acute Fatty Liver of Pregnancy :
Continued. .
Course and Management:
Patients with undiagnosed AFLP are at risk for progression.
With an unpredictable but often short time course, to fulminant hepatic failure and death for both mother and fetus.
Now it is rare for a patient to die, with appropriate diagnosis and aggressive management.
Similarly, the outlook for the fetus of the affected pregnancy has also improved, although it remains worse than that of the mother.
All patients should be hospitalized as soon as the diagnosis of AFLP is suspected.
Moderate or severely affected patients (encephalopathic, deeply jaundiced, with a prothrombin time less than 40% of the control), or with any extrahepatic complications, should be attended in intensive care units.
It seems convenient to maintain glucose infusions, because of the risk of a sudden hypoglycemia until a full metabolic recovery is obtained.
Treatment of AFLP begins with delivery.
The route should be guided by obstetric indications.
Cesarean section is not always necessary, vaginal delivery can be accomplished.
With delivery, repair of the liver disease begins, the initial sign of improvement being a fall in prothrombin time elevation.
The management should include maximal support in an intensive care unit by a team that includes both obstetricians and hepatologists.
Liver transplantation for AFLP has been reported.
There are no residua after AFLP, and complete recovery of the affected patient should be expected. Cases of recurrent AFLP, as well as cases of nonketotic hypoglycemia in the offspring, have been reported.
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