Acute Fatty Liver of Pregnancy and Its Clinical Manifestations

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric complication that typically occurs in the late stages of pregnancy. It is characterized by jaundice, coagulopathy, hepatic encephalopathy, and liver failure, posing severe risks to both maternal and fetal health. This condition often develops rapidly, with early symptoms being non-specific such as nausea, vomiting, abdominal pain, excessive thirst, and loss of appetite. As the disease progresses, profound jaundice develops, and the condition can rapidly worsen within one to two weeks.

Patients may experience skin bruising and gastrointestinal bleeding due to impaired blood clotting, which can quickly lead to multi-organ dysfunction, including renal and liver failure, altered mental status, and even coma or shock in the mother. These complications can also lead to preterm labor, fetal distress, or stillbirth.

Despite the high mortality rate associated with AFLP, it is a rare condition, most commonly seen in the third trimester. The exact cause remains unclear, although certain risk factors have been identified, including multiple pregnancies, malnutrition, low methionine intake, viral infections during pregnancy, and the use of tetracycline antibiotics.

Timely delivery is crucial in managing AFLP and improving outcomes, regardless of fetal maturity or viability. Immediate termination of pregnancy is recommended once the diagnosis is confirmed, alongside comprehensive supportive care to stabilize the mother's internal environment and organ functions. Early recognition and intervention are essential to reduce maternal and fetal complications and improve survival rates.