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Acute fatty liver of pregnancy

Authors
Richard H Lee, MD
Tram T Tran, MD
Section Editors
Keith D Lindor, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Acute fatty liver of pregnancy, characterized by microvesicular fatty infiltration of hepatocytes, is a disorder which is unique to human pregnancy [1]. It was described in 1940 and was initially thought to be universally fatal [2]. However, early diagnosis and prompt delivery have dramatically improved the prognosis, and maternal mortality should now be the exception rather than the rule [1].

The major clinical features of acute fatty liver of pregnancy will be reviewed here. A general approach to the pregnant woman who develops liver disease is presented elsewhere and has also been addressed in a guideline issued by the American College of Gastroenterology (table 1) [3]. (See "Approach to liver disease occurring during pregnancy".)

EPIDEMIOLOGY

Acute fatty liver of pregnancy is rare, with an approximate incidence of 1 in 7000 to 1 in 20,000 deliveries [4-8]. It is more common with multiple gestations and possibly in women who are underweight.

One of the largest population-based studies included 1,132,964 pregnancies at 229 hospitals in the United Kingdom between 2005 and 2006 [8]. There were a total of 57 women diagnosed with acute fatty liver of pregnancy (5 cases per 100,000 pregnancies, 95% CI 3.8-6.5). Of these, 18 percent of women had twin pregnancies and 20 percent were underweight (body mass index <20).

CLINICAL MANIFESTATIONS

Acute fatty liver occurs typically in the third trimester. The disease is always present before delivery, although it is not always diagnosed prior to delivery.

       

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 10 00:00:00 GMT+00:00 2015.
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References
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