From the Guidelines
The best treatment for acute fatty liver of pregnancy (AFLP) is immediate delivery of the baby, regardless of gestational age, along with intensive supportive care. This approach is supported by the most recent and highest quality study, which emphasizes the importance of prompt delivery in improving maternal outcomes 1. According to this study, there is no reason to delay delivery after diagnosis of AFLP, as perinatal mortality is high and maternal outcomes may be severely impacted by delayed delivery.
Key Components of Treatment
- Immediate delivery of the baby, regardless of gestational age
- Intensive supportive care, including:
- Intravenous fluids
- Glucose administration to prevent hypoglycemia
- Blood product transfusions to correct coagulopathy
- Close monitoring in an intensive care setting
- Management of complications such as renal failure, encephalopathy, and pancreatitis
- Temporary dialysis may be needed in severe cases
- Antithrombin III concentrates might be used in cases with significant coagulopathy
Rationale for Treatment
The underlying pathophysiology of AFLP involves a mitochondrial dysfunction in fatty acid oxidation, which is exacerbated by the metabolic demands of pregnancy, leading to microvesicular fatty infiltration of the liver 1. Early recognition and intervention are critical, as maternal mortality has decreased from historical rates of 70% to current rates of less than 10% with prompt treatment.
Additional Considerations
In cases where fetal demise has occurred, expedited vaginal induction could be considered instead of caesarean section 1. Additionally, women with AFLP who develop encephalopathy, elevated serum lactate, or a model for end-stage liver disease score >30 should be considered for level 2 or 3 care (intensive care admission) 1.
From the Research
Treatment Options for Acute Fatty Liver of Pregnancy (AFLP)
The treatment for AFLP typically involves a combination of supportive care and prompt delivery of the fetus. Some key aspects of treatment include:
- Early diagnosis and delivery: This is crucial in preventing further complications and improving outcomes for both the mother and the fetus 2, 3.
- Supportive care: This may include management of coagulopathy, hypoglycemia, and other complications associated with AFLP 2, 3, 4.
- Therapeutic plasma exchange: This has been shown to be effective in some cases of AFLP, particularly in patients with severe liver failure 5, 4.
- Multidisciplinary approach: Treatment of AFLP often requires a team of healthcare professionals, including obstetricians, hepatologists, and intensive care specialists 6.
Specific Treatment Strategies
Some specific treatment strategies that have been used in cases of AFLP include:
- Blood component transfusions: These may be necessary to manage coagulopathy and other complications 4.
- Plasma exchange: This can help to remove toxic substances from the blood and improve liver function 5, 4.
- Renal replacement therapy: This may be necessary in cases of acute renal failure 4.
- Antibiotic therapy: This may be used to prevent or treat infections associated with AFLP 4.
- Gastric and pancreatic secretion inhibitors: These may be used to manage symptoms such as nausea and vomiting 4.
Importance of Prompt Treatment
Prompt treatment of AFLP is critical in preventing further complications and improving outcomes for both the mother and the fetus. Delayed treatment can lead to severe consequences, including maternal and fetal mortality 2, 3, 4. Therefore, it is essential to suspect AFLP early and initiate treatment promptly in patients with suspicious symptoms or laboratory findings.