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AFLP Immediate Delivery AKI — ESENeph MCQ

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HardPregnancy & RenalAFLP Immediate Delivery AKIESENeph

A 38-year-old woman at 34 weeks' gestation develops acute fatty liver of pregnancy (AFLP). She has jaundice, coagulopathy, and rising creatinine (280 umol/L). Platelet count is 78 x 10^9/L. She is mildly encephalopathic. What is the MOST important management step?

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Correct answer: C — Immediate delivery regardless of gestational age

AFLP is a life-threatening obstetric emergency requiring immediate delivery regardless of gestational age. It is caused by defective mitochondrial fatty acid oxidation (maternal heterozygosity for LCHAD deficiency is an associated genetic risk). The condition causes microvesicular hepatic steatosis with progressive liver failure, coagulopathy (DIC), encephalopathy, AKI, and hypoglycaemia. Without delivery, it is fatal. Post-delivery, liver function typically recovers completely within 1-4 weeks, as does renal function. Delaying delivery for steroid-induced fetal lung maturation is inappropriate when the maternal condition is immediately life-threatening. The AKI is multifactorial (hepatorenal + DIC + volume depletion) and resolves post-delivery.

Reference: RCOG 2022 – AFLP Green-Top Guideline; Knight et al 2008 – AFLP UK Surveillance