CLERKING

P R E S E N TAT I O N 2
PRESENTING
C O M P L A I N T:
• Nausea and vomiting
• Lack of appetite
• Abdominal pain
• Excessive tiredness (fatigue)
• Jaundice
 A C U T E FAT T Y L I V E R O F P R E G N A N C Y
(AFLP)

• Rare but potentially fatal condition for both mother and baby, as often the diagnosis is
delayed.
• Occurs in the latter part of pregnancy.
• Can cause multiple organ failure.
• Early diagnosis and prompt delivery is the mainstay of treatment.
• Incidence 1:20 000 maternities
A E T I O L O G Y:

• - Unknown
• -Theories:
• Variant of pre-eclampsia
• Inherited enzyme deficiency called long chain acyl-CoA dehydrogenase (LCHAD) in the
baby.
• Foetus unable to metabolise free fatty acids (FFA) normally
• Un-metabolised FFA return to mother’s blood stream
• Hepatic stress on mother’s liver
C O M M O N C O M P L I C AT I O N S :

• Renal failure (60%),

• Infection (45%)
• Coagulopathy (30%),
• Hepatic failure
• Hypoglycaemia (53%),
• Gastrointestinal haemorrhage (33%),
• Severe postpartum haemorrhage
• Stillbirth
DIAGNOSIS:

• Family history of LCHAD from both sides of the family

• Blood tests to rule out Acute Viral Hepatitis / pre-eclampsia / HELLP syndrome / Intrahepatic
cholestasis
• Raised ALT and AST
• Abnormal white cell count, kidney function, blood glucose and lactic acid levels
• Ultrasound, CT, or MRI to check for liver abnormalities
The condition is closely related to and can be difficult to differentiate from HELLP syndrome.
M A N A G E M E N T:
• Supportive Care in a multidisciplinary team ( inform obstetric , anaesthetic and ITU consultants)
• Aggressive management of coagulopathy with Fresh Frozen Plasma, Cryoprecipitate)
• Aggressive management of hypoglycaemia with 50% intravenous glucose
• Expedite delivery if antenatal

• Mode of delivery
• Caesarean section (consider coagulopathy state)

• Mode of anaesthesia
• GA
• Regional – risk of spinal haematoma in presence of coagulopathy
• Consider using N-acetyl Cysteine

• Reduce cerebral oedema :

• Raising the head of the bed, use of IV sedation, oral Lactulose, Hyperventilation.
THANK YOU