Second and third trimesters :
Acute Fatty Liver of Pregnancy:
Sheehan, first recognized this disorder as a distinct syndrome in 1940.
He named it Acute yellow atrophy but it is now more commonly known as acute fatty liver of pregnancy.
It is rare, encountered in a tertiary maternity hospital approximately once a year, with a reported incidence of 1 in 13,000 to 1 in 16,000 deliveries.
Preeclampsia is present in 50% or more of cases of AFLP and may play a role in its origin.
Reports of occasional recurrent cases and an association with a deficiency of long-chain 3-hydroxyacyl-cocnzyme A (Co A) dehydrogenase, raise the interesting notion that, at least in some instances, this disease results from an inborn error of metabolism.
Clinical Characteristics:
AFLP occurs in the latter half of pregnancy, usually close to term.
As with HELLP syndrome, affected patients may present after delivery.
It is reported to occur more commonly in a first pregnancy and in the presence of multiple pregnancy, also prevalent in preeclampsia.
There are reports of an association between AFLP and gestation of a male fetus.
Affected women have nonspecific symptoms, including, nausea and vomiting, malaise and fatigue, jaundice, thirst, headache and altered mental status.
These can be signs and symptoms of acute hepatic failure.
In severe cases that go untreated, there is progression over hours or days to fulminant hepatic failure, with hepatic coma, hypo-glycemia, severe coagulopathy with hemorrhage from the gastrointestinal tract or the uterus and death.
Most affected women have signs of coexistent preeclampsia, including modest elevations in blood pressure, hyperuricemia and proteinuria.
Polydipsia with or without polyuria, frequently is an early symptom in AFLP.
The patient may drink 2 or 3 liters of liquids overnight, it often exceeds the magnitude of vomiting. It has been interpreted as a transient diabetes insipidus.
Acute Fatty Liver of Pregnancy:
Sheehan, first recognized this disorder as a distinct syndrome in 1940.
He named it Acute yellow atrophy but it is now more commonly known as acute fatty liver of pregnancy.
It is rare, encountered in a tertiary maternity hospital approximately once a year, with a reported incidence of 1 in 13,000 to 1 in 16,000 deliveries.
Preeclampsia is present in 50% or more of cases of AFLP and may play a role in its origin.
Reports of occasional recurrent cases and an association with a deficiency of long-chain 3-hydroxyacyl-cocnzyme A (Co A) dehydrogenase, raise the interesting notion that, at least in some instances, this disease results from an inborn error of metabolism.
Clinical Characteristics:
AFLP occurs in the latter half of pregnancy, usually close to term.
As with HELLP syndrome, affected patients may present after delivery.
It is reported to occur more commonly in a first pregnancy and in the presence of multiple pregnancy, also prevalent in preeclampsia.
There are reports of an association between AFLP and gestation of a male fetus.
Affected women have nonspecific symptoms, including, nausea and vomiting, malaise and fatigue, jaundice, thirst, headache and altered mental status.
These can be signs and symptoms of acute hepatic failure.
In severe cases that go untreated, there is progression over hours or days to fulminant hepatic failure, with hepatic coma, hypo-glycemia, severe coagulopathy with hemorrhage from the gastrointestinal tract or the uterus and death.
Most affected women have signs of coexistent preeclampsia, including modest elevations in blood pressure, hyperuricemia and proteinuria.
Polydipsia with or without polyuria, frequently is an early symptom in AFLP.
The patient may drink 2 or 3 liters of liquids overnight, it often exceeds the magnitude of vomiting. It has been interpreted as a transient diabetes insipidus.
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