Acute Liver Failure in Pregnancy: Diagnosis and Early Intervention

Challenges unique to pregnancy include imaging modalities, fetal monitoring, mode of delivery, challenges in cesarean section and caregiver crisis.

 The approach to acute liver injury/acute liver failure (ALF) in pregnancy involves assessing background liver disease.

 If there is no background disease and the patient is not in the late 2nd or 3rd trimester, perform work up for nonunique causes as per ALF protocols, provide ALF care and consider liver transplantation (LT).

If background liver disease is present and the patient is in the late 2nd or 3rd trimester, work up for nonunique causes as per ALF protocols, provide ALF care and decide on delivery/LT based on fetal viability.

In the presence of unique disorders like acute fatty liver of pregnancy (AFLP) or hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or preeclampsia, expedite delivery and consider LT.