Acute fatty liver of pregnancy [Incidence, pathogenesis, diagnosis, treatment and prognosis]

Acute fatty liver of pregnancy [AFLP] is a rare, potentially fatal complication that occurs in the third trimester or early postpartum period. It generally appears between weeks 30 and 38. Usually the APLF symptoms start one to two weeks before hospitalization with nausea, emesis, general uneasiness, jaundice, epigastric pain and other symptoms. A careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. The maternal outcome has improved enormously during the last decade. Early diagnosis, pregnancy interuption and handling in special care or treating complications has lead to good materno-fetal results

Contribution of the liver biopsy in intensive care unit

Our aim was to evaluate the indications and contribution of liver biopsy [LB] in intensive care [ICU] and to compare them to those of LB in gastroenterology. We included retrospectively 37 successive LB achieved in ICU and 38 successive LB achieved in gastroenterology. All data were reviewed by three intensivists and three gastroenterologists to determine the contribution of the LB. The indications of LB were different in the two units. The most frequent indications were cirrhosis [36.8%], isolated biological hepatic disruptions [26.3%] and histological classification of viral hepatitis [18.4%] in gastroenterology and isolated biological hepatic disruptions [48.6%], hepatopathy during pregnancy [27%] and fever of unknown origin [10.8%] in intensive care unit. According to the six reviewers, LB was enough contributive in the two units, [78.4% in ICU and 71.1% in gastroenterology -p=0.46-]. It allowed to eliminate, to confirm, or to change a diagnosis in more than 70% of cases and allowed to modify the course of therapy in 21.6% of cases in ICU and in 26.3% of cases in gastroenterology [p=0.6]. The LB is a feasible technique in ICU and can be as contributive as it is in gastroenterology