Acute Fatty Liver Of Pregnancy:A Single Center Retrospective Analysis Of 95 Cases

Objectives:This study aims to explore the clinical characteristics and outcomes of patients with AFLP in a tertiary centre in an Eastern Chinese province,to provide clinicians with a rational presumption of the time taken for multi-organ system abnormalities related to AFLP to recover and to briefly evaluate the prognosis of women presented with AFLP and discharged at our center.Patients and Methods:We performed a retrospective study of 95 patients with a diagnosis of acute fatty liver of pregnancy between November 2009 and May 2017.We analysed the clinical features,laboratory results and materno-fetal outcomes.All data were analysed using STATA v14 and Microsoft Excel 2010.Fisher’s exact chi-square test was performed and p<0.05 was set as statistical significance.Results:Totally,95 patients were included in our study.The estimated incidence in Qilu hospital was 29 per 10,000 deliveries.Jaundice was the presenting complaint in most of the women in our study(42.1%);others observed were abdominal pain,nausea,vomiting and malaise.Average maternal age was 27.7 ± 4.8 years(ranging from 20 to 40).Mean gestational age was 35.5±2.8 weeks(ranging from 24 to 40).The average value of aspartate transaminase(AST)and alanine aminotransferase(ALT)at onset was 272.41 ±236.55 and 244.29± 166.15 U/L,respectively.Meanwhile,patients tend to have coagulation disorders.fibrinogen declined with an an average of 1.65±1.22 g/L,fibrin degradation products(FDP)was elevated with an average of 45.49±44.14 ug/ml,D-Dimer was elevated with an average of 21.64±93.00 ug/ml,prolonged prothrombin time(PT-Sec)21.19±9.59s and prolonged atypical partial thromboplastin time(APTT-Sec)50.83±21.13s.The mean follow-up time was 32 months.62(66.6%)women were contacted,the rest were unavailable.There were 2 maternal and 7 fetal deaths.Fetal death mostly occurred in mothers with blood group O+.Post-partum haemorrhage(PPH)17.8%(17),acute renal injury 9.4%(9),anaemia 26.3%(25),thrombocytopenia 11.6%(11)and disseminated intravascular coagulation(DIC)17.9%(17)were the most common complications found in our study.Liver function was regained within 7-12 days,renal function after 4 days and haematological function after a week.Conclusion:a)AFLP is more likely to occur in women presenting with gestational age above 34 weeks.b)Jaundice,nausea,vomiting and abdominal pain were the most frequent clinical manifestations observed.c)Complications that are more likely to occur are acute hepatic failure,acute renal injury,thrombocytopenia,PPH and DIC.d)Acute Renal Injury is most likely to occur in women presenting with gestational age ≤34 weeks.e)PPH and DIC are complications that are most likely to occur in women presenting with AST levels<300u/l and ALT levels ≤150u/l.f)Hepatic dysfunction was mostly arrested 7-12 days after delivery,renal function was mostly regained within a week and coagulopathy was arrested within 7-10 days after delivery.g)Most of the women fared on well after delivery of the fetus.