What are the causes of acute liver failure (ALF) during pregnancy?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Acute fatty liver of pregnancy (AFLP) frequently culminates in fulminant hepatic failure. [21] AFLP typically occurs in the third trimester; preeclampsia develops in approximately 50% of these patients. AFLP has been estimated to occur in 0.008% of pregnancies.

The most common cause of acute jaundice in pregnancy is acute viral hepatitis, and most of these patients do not develop fulminant hepatic failure. The one major exception to this is the pregnant patient who develops hepatitis E virus infection, in whom progression to fulminant hepatic failure is unfortunately common and often fatal.

The exposure history in patients with hepatitis E is usually remarkable for travel and/or residence in the Middle East, India and the subcontinent, Mexico, or other endemic areas. In the United States, hepatitis E is relatively uncommon but must be considered in the appropriate setting.

The HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome occurs in 0.1-0.6% of pregnancies. It is usually associated with preeclampsia and may rarely result in liver failure.

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