AFLP syndrome

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Fatty Liver

AFLP is an abbreviation of "Acute Fatty Liver in Pregnancy" Fatty Liver is a condition that typically occurs in alcohol abusers, and develops over an extended period of time as a result of chronically consuming too much alcohol. The liver is not capable to break down the alcohol sufficient fast, and instead the alcohol is transformed in fat and stored in the liver. If that development continues, the liver eventually ceases to function.

There is one reliable method to diagnose Fatty Liver, and that is by means of a biopty, where a small fragment of liver tissue is removed and analyzed. When the liver cells are infiltrated with fats, Fatty Liver is diagnozed. A biopty is an intrusive operation, so if possible it is avoided. Alterantively, sypmtoms that often point to Fatty Liver include: elevated liver enzyme levels, lowered blood glucose levels, lower blood platelet counts, higer blood pressure, nausea, no appetite, and vomiting. In other words, the patient feels pretty sick.

What is AFLP?

In some cases, a similar condition develops in the third trimester of pregnancy. The unfortunate thing about this variant is that it is acute, in other words it develops rapidly: within a couple of hours. On top of that, many of the symptoms (nausea etc) are very common in advanced stages of pregnancy, which complicates make an accurate diagnosis.

So AFLP is not related to excessive alcohol abuse during pregnancy, and it develops alarmingly fast. AFLP is also rare; it occurs in one of 13,000 to 16,000 pregnancies. There has not been much data to work with for docters. Because of that it is not clear how it develops or causes it, and worse, is often misdiagnosed for something less serious by doctors. With potentially severe consequences.

What is known is that with AFLP there is an interaction between the unborn child and the mother's liver. Birth of the child is therefore the (only) solution. The faster the better, because the prospects for recovery decrease rapidly for mother and child. When AFLP is diagnosed it is usually followed by an emergency C-section. When the child is born, usually either recovery of the mother starts immediately, or it is followed by a period of 24 to 48 hours of further deterioration before the situation improves.

Is it bad?

Yes. Not only is it hard to diagnose, but the consequences for mother and child can be severe. In thirty percent of the cases the child does not survive, and in 20 percent of the cases the mother dies. In those cases where the mother does survive, often she slides in a coma, a long period of stay in the intensive care unit, and often a liver transplant is necessary. This is the result of the often sever damage that the liver suffers from, such as a ruptured liver. Another side effect can be that the clotting factor drops so far that hemorrhaging can occur. Kidneys and other internal organs can sustain considerable damage as a result of the problems with the liver.

A good diagnosis is therefore of prime importance. Each of the gynecologists that we talked to had experienced this two or three times in their careers of 15 to 20 years. Most of the patients had died in those cases, a few survived, usually with a need for a donor liver. We have been very, very lucky that we went to the hospital early, that Wilma listened to her body that something was not quite right, and that we were received by gynecologist dr. Heffernan who did not trust the case entirely and ordered blood tests right away..

And now?

Wilma is doing fine now, however she still tires very quickly; her liver is on the road to full recovery three weeks after Bram was born. It will take a couple of months before she is fully recovered, but we cannot complain.

It is unknown if there are heredetary factors. There are some indications that there is an interaction between a genetic condition of the mother and a metabolic disorder in the child. In that case the chance of repeat in subsequent pregnancies would be 25%, but not a lot information is available. Potential future pregnancies will be treated as high risk, and evertyhing will be tracked meticulously.

But this might take a while...