Acute fatty liver of pregnancy

The condition was previously thought to be universally fatal,[3] but aggressive treatment by stabilizing the mother with intravenous fluids and blood products in anticipation of early delivery has improved prognosis.

[1][6] In patients with more severe disease, pre-eclampsia may occur, which involves elevation of blood pressure and accumulation of fluid (termed oedema).

[citation needed] The understanding of the causes of acute fatty liver of pregnancy has been improved by advances in mitochondrial biochemistry.

When this occurs in the foetus, the unmetabolized fatty acids will re-enter the maternal circulation through the placenta, and overwhelm the beta-oxidation enzymes of the mother.

[3] If a liver biopsy is needed for diagnosis of the condition, the mother should be appropriately stabilized and treated to reduce bleeding related complications.

On the regular trichrome stain, the liver cell cytoplasm shows a foamy appearance due to the prominence of fat.

[18][19] Liver diseases with similar appearances include Reye's syndrome, drug-induced hepatitis from agents with mitochondrial toxicity, including nucleoside reverse transcriptase inhibitors used to treat HIV,[20] and a rare condition known as Jamaican vomiting sickness which is caused by the eating of the unripened Ackee fruit.

[21] Acute fatty liver of pregnancy is best treated in a centre with expertise in hepatology, high-risk obstetrics, maternal-fetal medicine and neonatology.

[citation needed] The complications of acute fatty liver of pregnancy may require treatment after delivery, especially if pancreatitis occurs.

[3][19] The mortality from acute fatty liver of pregnancy has been reduced significantly to 18%, and is now related primarily to complications, particularly DIC (Disseminated Intravascular Coagulation) and infections.