Acute Fatty Liver Syndrome of Pregnancy

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Hello, I recently took care of a pt w/ this diagnosis. She was 26 and her 4th pregnancy. She was healthy up until her 36th week. N/v set in, but her other children were sick, so she thought nothing of it. She did have the edema, but it was in all her pregnancies. She came to the hospital and the baby was found to be in severe distress. A crash c-section performed and the infant released meconium in the uterus. THe baby was sent to Children's Hospital on a vent and survived with seizures and is on Dilantin. The mother came to us in critical condition when she would not breathe on her own after the section. She woke up in the morning and extubated. Liver enzymes were sky high and bili was up, but no jaundice. Ct of abd showed nothing and kidney failure set in. Also, DIC set in and supportive therapy started. 2 weeks later she was allowed out of the unit and to the birthing center to stay with her newborn. She ended up having surgery for infection of the uterus. The uterus was necrotic and sepsis had set in. We could not save her.:o Help me understand what happened. Did I mention she was a co-worker. We had never seen this at our hospital. We had experts from University Hospital, and she was recovering from the Fatty Liver. Mortality rates from this syndrome is not that high 18%. I just found out I'm pregnant and am scared to death. I know this is very rare. Has anyone seen it and what was the treatment? I know it was the infection that was the killer. The MD's attempted to do a hysterectomy earlier, but she refused. Sorry so lengthy.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Seeing as this is a coworker (WOW--I am Sorry so sorry about that)--- and you yourself are pregnant, I want to approach this subject very carefully. You are clearly in a very tough position right now and I want to be sensitive to your needs here.

FIRST ----PLEASE!!!!---I highly recommend you get some counseling/debriefing on this situation. It's so close, so tragic, so traumatic for you and your coworkers. Take advantage of any Employee Assistance Programs you have, and at the very least, ask your manager to set up a debriefing for your unit and most especially, anyone directly-involved in her tragic case. At the very least, talk to someone who is not directly-involved about how you feel and let it all "out", so to speak. If you have problems at work (yes, PTSD is a concern here), you must seek ongoing counseling to help you cope.

SECOND--- I will find you some excellent articles on acute fatty liver of pregnancy. Give me a little time and I will try to post them here. Fortunately, please remember, it is VERY rare and not likely to happen to You. I want you to try not to put yourself in this situation and worry unduly. You have to take care of yourself and address any and all concerns you have in your own pregnancy with your health care provider as soon as they come up.

THIRD---- I want to sincerely express my condolences on the loss of your coworker. I am so sorry for her family, her kids, for you all. SO sad.

Last, congratulations on your pregnancy. I hope it's healthy, joyful and uneventful. Take care of yourself, in every way, physically, mentally and emotionally, please!

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Specializes in L&D.

I have had one patient in my 6 year nursing career who had Acute Fatty Liver of Pregnancy.

The patient I was caring for was around 37 weeks and already post c/s delivery, post op day 1. She was already diagnosed with preeclampsia, and was on magnesium sulfate therapy. When I received report in the morning, looking at her out of whack coagulation (clotting) studies, my first thought was DIC (disseminated intravascular coagulation) -- and getting this sick woman to the ICU.

Creatinine was hanging around 2.5, uric acid at 8.0, fibrinogen was 65, down from 72 the day before. PT/INR/PTT were all prolonged. Bilirubin level above 5 (normal is under 2). Platelets were 150,000 and her WBC count was over 35,000.

She decompensated as the morning progressed, with a decrease in her neurological condition (DTR's and lethargy), and a decline in her renal function. She did not belong in L&D, and was eventually transferred to the ICU with a tentative diagnosis of Acute Fatty Liver of Pregnancy. She was rapidly heading towards hepatic and renal failure. Her magnesium was shut off right before transfer to the ICU. Care to guess on what her Mag level was, before I turned off the Mag? It was a whopping 11.7!! Therapeutic levels while on mag sulfate therapy is around 6. Normal everyday levels for you and me - under 2.5

If her labs continued to worsen, she would be transferred out of state to a different hospital and possibly need a liver transplant.

Luckily, she recovered on her own within several days and was transferred to post partum.

How was her baby you might ask? In the NICU due to fetal distress that led to her emergency c/s delivery.

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We've never had a patient here since I've been working . . .. did some searches on google. One site was good - see below:

http://www.obgyn.net/english/pubs/features/presentations/abdalla12/AFLP.ppt

steph

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We have only had one at my hospital. She ended up doing ok but had to leave the hospital without her baby due to a fetal demise.

A very sad and tragic illness for labor and delivery to deal with.

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