Acute Fatty Liver of Pregnancy (AFLP)

By Dr. Chetan Kalal

First DM Hepatologist of Maharashtra | Liver & Pregnancy Expert | Women's Liver Health Advocate

What is Acute Fatty Liver of Pregnancy (AFLP)?

AFLP is a rare but life-threatening liver disorder that occurs typically in the third trimester or early postpartum period.

"AFLP is a medical emergency — both mother and baby's lives depend on early recognition and rapid management."
— Dr. Chetan Kalal

Why Does AFLP Happen?

• The exact cause is unclear — but mitochondrial dysfunction in fatty acid metabolism (especially LCHAD enzyme deficiency) is implicated.

• Fatty acids accumulate in maternal liver → Rapid liver failure.

Who is at Risk?

Maternal Risk Factors

• First pregnancy

• Multiple gestation (twins/triplets)

• Low BMI mother

• Previous history of AFLP

• Family history of liver disease

Fetal Risk Factor

• Baby with fatty acid oxidation disorder

Clinical Presentation — What To Watch For?

Usually in 3rd Trimester (30-38 weeks)

Early Symptoms (Non-specific)

• Nausea

• Vomiting

• Malaise

• Abdominal pain (especially RUQ)

• Jaundice

Red Flag Symptoms

• Altered mental status

• Hypoglycemia (Low sugars)

• Hypertension

• Coagulopathy (Bleeding tendency)

• Acute Kidney Injury

• Encephalopathy

Diagnosis of AFLP

"High index of suspicion is key — Delayed diagnosis increases mortality." — Dr. Chetan Kalal

Swansea Criteria

(A scoring system based on clinical and laboratory features — 6 out of 14 needed)

Investigations

• Liver function tests — ↑ AST/ALT

• Hypoglycemia

• Coagulopathy (↑ INR)

• Hyperbilirubinemia

• Leukocytosis

• Low platelets

• Elevated Ammonia

• Imaging — Fatty liver on USG or MRI

• Rule out HELLP Syndrome & Viral Hepatitis

Management of AFLP

"Delivery is the definitive treatment — delay can cost lives." — Dr. Chetan Kalal

Step 1 — Stabilize Mother

• ICU admission

• Correct hypoglycemia

• Manage coagulopathy (FFP, Platelets)

• Control hypertension

• Renal support if needed

Step 2 — Plan for Delivery

• Vaginal delivery if possible

• Cesarean if urgent

Step 3 — Postpartum Monitoring

• Liver recovery usually within 1-2 weeks

• Monitor for complications — bleeding, renal failure, infection

Maternal & Fetal Outcomes

Long-Term Prognosis

• Most women recover completely if managed early.

• Risk of recurrence is low — unless underlying genetic fatty acid oxidation disorder is present in fetus.

• Genetic counseling may be advised for future pregnancies.

Dr. Chetan Kalal's Expert Advice

"Pregnancy is a beautiful journey — but liver health screening should be an integral part of antenatal care especially in high-risk women."

Keywords

• Acute Fatty Liver of Pregnancy Specialist Mumbai

• Pregnancy Liver Doctor India

• Liver Complications in Pregnancy Expert

• Dr. Chetan Kalal Liver & Women's Health

• AFLP Treatment Expert Maharashtra

"Acute Fatty Liver of Pregnancy (AFLP) is rare but deadly. Timely diagnosis can save two lives — Mother and Baby. Know more with Dr. Chetan Kalal, Maharashtra's First DM Hepatologist and Women's Liver Health Expert."

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