AFLP

KALYANI S
ROLL NO : 45
•This is a serious disorder
occurring in late pregnancy,
which is often fatal for both the
mother and fetus.
AETIOLOGY
• First pregnancy
• Male fetuses
• Preeclampsia
• Maternal obesity
• Multiple pregnancies
• This is caused by an autosomal recessive
genetic error.
• Specific enzyme defect is long chain 3-hydroxyl
acyl Co A Dehydrogenase (LCHAD) deficiency.
• Fetus produces abnormal fatty acid metabolites
which lead to maternal microvascular stenosis
and in extreme cases liver failure.
DIAGNOSIS

• CLINICAL FEATURES : ( THIRD TRIMESTER)

1. Nausea
2. Vomiting
3. Anorexia
4. Vague abdominal discomfort
5. Malaise
6. Followed by jaundice after one week
• Signs of preeclampsia are present
• Progressive worsening of maternal conditions
• In severe cases,there will be endothelial cell activation
with capillary leakage causing haemo
concentration,hepato renal problems,ascites and
pulmonary edema.
• Still birth can occur
• Hypoglycemia is common
• Hepatic encephalopathy,coagulopathy and renal failure
in 50% cases.
DIFFERENTIAL DIAGNOSIS

• Preeclampsia with HELLP Syndrome

• Viral hepatitis
INVESTIGATIONS

• LFT are abnormal with increased serum bilirubin and moderate increase in
SGOT and SGPT and alkaline phosphatase.
• Prothrombin time increased
• Disseminated coagulation failure in severe cases.
• Haemolysis and thrombocytopenia
• Increase in uric acid
• USG shows classic feature of ascites or bright liver
MANAGEMENT

• Rapid delivery is essential

• Multidisciplinary approach involving
hepatology,nephrologist ,anesthetist and
intensivists.
• Prompt initiation of supportive therapy including
correction of hypoglycemia and transfusion of
blood products to correct coagulopathy may be
life saving.
PROGNOSIS

• Maternal mortality
1. Due to hepatic failure leading to hepatic encephalopathy,renal
failure and coagulopathy.
2. MR approx. 10% in rural India and centres where facilities for
management of complications are not available.
3. MR can be very low in teritiary centres
4. Liver functions usually returns to normal in a week or may be
delayed for months
• Perinatal Mortality
1. Rates can be as high as 85%
2. Major cause of perinatal mortality is preterm birth due to urgent
need for delivery.
Thank You