Objective: To retrospectively analyze the clinical characteristics of patients with
acute fatty liver of pregnancy (AFLP), and to discuss perioperative and
anesthetic management. Methods: A retrospective review was conducted on the records of pregnant patients with a diagnosis of
acute fatty liver of pregnancy in Peking University Third Hospital from January 2007 to December 2015. 12 cases were identified. The clinical features, preoperative laboratory findings, types of delivery,
anesthetic techniques for
cesarean section, and the outcomes of parturients and fetus were collected and analyzed. Results: Among the 12 cases, 91.7% were primigravid, 50% had twin pregnancies, and one was diagnosed with concomitant
preeclampsia. The common clinical features included
nausea (6 cases, 54.5%),
vomiting (5 cases, 45.5%),
jaundice (5 cases, 45.5%), malaise (3 cases, 27.3%), epigastric discomfort (2 cases, 18.2%),
anorexia (2 cases, 18.2%) and regurgitation (1 case, 9.1%). Laboratory tests mainly showed impaired hepatic function and
hypoglycemia. Cesarean deliveries were performed in 10 of the 11 patients diagnosed antepartum.
Cesarean section was performed under neuraxial
anesthesia (1 case) or
general anesthesia (9 cases). The patient transferred to our center after delivery and diagnosed postpartum died. All the patients diagnosed antepartum survived. 6 out of the 18 fetuses were transferred to the pediatric department due to preterm, low birth weight, intrauterine restriction or asphyxiation, and were all survived. Conclusions: AFLP is one of the most severe complications in parturients. Prognosis can be improved with early diagnosis and prompt termination of pregnancy. Hepatic function, coagulation status and urgency of delivery should be well considered to choose the appropriate
anesthetic method, and
anesthetic management should be individualized.