Fatty liver of pregnancy
What is a pregnancy fatty liver?
Pregnancy fatty liver is a rare complication that leads to severe liver function impairment in the expectant mother. There is an excessive accumulation of fat in the cells of the liver (hepatocytes), which makes the liver perform their versatile tasks more limited.
Typically, symptoms only manifest in the last trimester and can be life-threatening. The pregnancy fatty liver is basically reversible; All symptoms return after delivery. The incidence of this pregnancy complication is estimated to be between 1: 7000 and 1: 16000.
Accurate numbers are not available due to the rarity of this hepatic disease. The diagnosis is a major challenge for the treating physicians. Doctors of various disciplines such as hepatology, neonatology, surgery and gynecology need to work together to rule out other possible conditions.
The exact causes for the training of a pregnancy obese are still unclear. Perhaps a genetic bias plays a role in the genesis. In some families, this complication occurs more frequently, suggesting involvement of hereditary factors.
In addition, the use of certain medicines such as antiepileptic drugs may increase the risk of disease. In exceptional cases, the disease could be linked to the use of antibiotics during pregnancy. In this hepatological disease, the fatty acid degradation, the so-called beta-oxidation, is disturbed in the cells of the liver.
Fatty acids can not be properly broken down and metabolized, which leads to an accumulation of fat in the hepatocytes. If this process is not stopped, more and more fat accumulates in the liver until liver failure occurs. The exact pathogenesis is unknown. In rare cases, an enzyme defect in the fetus plays a role in the development of pregnancy fatty liver.
Symptoms, complaints & signs
An acute pregnancy fatty liver occurs mostly around the 35th week of pregnancy and is associated with many nonspecific symptoms. Frequently affected women suffer from pain in the upper abdomen, loss of appetite, tiredness, headache, nausea and vomiting.
Persistent back pain can also occur. Most of the time, the symptoms start slightly and increase in intensity over time. At an advanced stage it comes to jaundice, while the skin, especially the conjunctiva of the eyes, yellow. Affected women usually have a very fast heartbeat. The liver is responsible for producing the coagulation factors of the blood.
In case of a restriction of the liver function, problems with blood coagulation can occur. Affected women show punctate hemorrhages in the skin. Mucous membranes are often affected by these minor bleeding. During childbirth there is an increased tendency to bleed.
In severe cases, pregnancy obesity causes bleeding in the digestive tract, renal insufficiency and hepatic encephalopathy with coma. This can lead to the death of the expectant mother and the unborn child. Such severe cases are rare, as the pregnancy is usually terminated before the condition of pregnant women worsens.
Diagnosis & disease course
Due to the nonspecific symptoms, the diagnosis of a pregnancy obesity is complex and time consuming. For advanced pregnancy and symptoms of liver dysfunction, a blood test is first made. An ultrasound examination is not always meaningful.
If there is no coagulation disorder, diagnosis can be made by biopsy of the liver and subsequent histological examination. Pregnancy fatty liver is a serious condition that, if left untreated, can lead to the death of the mother and child. With rapid therapy, however, the prognosis is considered positive.
Just as rare as the pregnancy fatty liver itself are the associated complications. But if they do occur, they can have serious consequences.
Possible sequelae of pregnancy fatty liver show up only in the last part of the pregnancy. On average, this is the 35th week of pregnancy. At first, the affected women often suffer from loss of appetite, tiredness, nausea, vomiting, headache, back pain and painful upper abdominal complaints. Other effects include a yellowish discoloration of the skin and the conjunctiva and an accelerated heartbeat.
If the course of pregnancy obesity is intense, threaten complications such as renal insufficiency (kidney failure) and bleeding within the gastrointestinal tract. In extreme cases, the pregnant woman may fall into a coma. Because liver and blood clotting function are also affected by the pregnancy fatty acids, it sometimes comes to disorders of blood clotting.
Noticeably they make themselves punctate small bleeding on skin and mucous membrane. During labor, major bleeding is possible. Furthermore, extensive bruising may form on the liver. Due to the associated increase in pressure there is a risk of a liver tear.
The effects of acute pregnancy obesity also include serious metabolic disturbances such as low levels of sodium and potassium in the blood, hypoglycaemia or protein breakdown. In some cases, an acute pancreatitis also develops. In the worst case, these serious complications even result in the death of the pregnant woman or her child.
When should you go to the doctor?
A pregnancy obese must always be treated immediately by a doctor. It is a serious condition that, if left untreated, can lead to serious complications and discomfort. The earlier the pregnancy fatty liver is detected and treated, the better the further course. A doctor should be consulted if the person suffering from severe pain in the abdomen or a strong loss of appetite.
It can also lead to a significant fatigue and nausea or severe headache. Furthermore, frequent vomiting may point to the fetal pregnancy and should be examined by a doctor if it occurs permanently and does not disappear on its own. In many cases it comes to complaints on the skin, jaundice or severe pain in the back. Even with these complaints, a doctor should always be consulted.
In case of a pregnancy fatty liver, a gynecologist or a general practitioner is usually consulted. The further treatment then takes place in a hospital. In most cases, the disease can be treated relatively well if diagnosed at an early stage so that the life expectancy of the mother and child is not compromised.
Treatment & Therapy
The only causative therapy for a pregnant woman is in the initiation of childbirth. Depending on the situation and the state of health of the pregnant woman, a medical induction of labor or a cesarean section may occur. The birth of the child is usually as fast as possible to prevent acute liver failure of pregnant women.
Because it is a serious complication, affected women are mainly treated in the intensive care unit. This is necessary because, among other things, the state of health can worsen very quickly and require immediate action. It may be necessary to have a blood transfusion.
The administration of coagulation factors is particularly important in advanced fatty liver, to counteract the bleeding tendency. After delivery, the neonate is examined for enzyme defects and, if necessary, further treatment is initiated. If delivery has been initiated early enough, the disease is rapidly declining and pregnant women can leave the hospital a few weeks after birth.
In severe cases, there may be no postpartum improvement in liver function. If there is acute liver failure, only a liver transplant can save the woman's life. Affected women need to be educated about the risk of re-illness in another pregnancy after recovery.
At present, it is not known exactly what leads to the development of a pregnancy observer. A targeted prevention is therefore not possible. In known cases of hepatic complications during pregnancy in the family, this should be discussed with the attending gynecologist at a check-up.
Under certain circumstances, close check-ups may be required in the last trimester of pregnancy. In addition, the use of medication during pregnancy should definitely be discussed with a gynecologist. In general, the disease is so rare that most pregnant women have no cause for concern.
Since it is a disease that occurs temporarily in the context of pregnancy, it is quite possible that it will regress spontaneously after delivery. The body can get back to normal metabolism.
The aftercare is very different depending on the course of the disease. Follow-up examinations are necessary and regular blood collection with determination of liver enzymes. Over this the course and the healing can be recognized very well. The sonographic examination can also give indications of the healing.
However, it is likely that the body will need some time after pregnancy to regulate the processes and reduce the fat stored in the liver. In difficult cases, a consistent change in lifestyle habits may be required. This refers in particular to the diet and the increase of sports activities.
Even after the pregnancy fatty liver has healed, a healthy lifestyle should be continued. For this purpose, the attending physician can provide appropriate tips and assistance during the follow-up examinations. Complicated courses with heavy weight gain and persistent fatty liver disease should always be monitored and co-administered by a savvy gastroenterologist, as this can lead to recurrent symptoms.
You can do that yourself
This life-threatening condition for women and their unborn baby is rare. However, it forces the doctors to act: the child must be discharged as soon as possible, so that it does not lead to serious cases with serious complications. The affected mothers therefore do well to agree to premature birth.
All the symptoms of a pregnancy fatty liver, in most cases, go back after the child is discharged, so they are reversible. Nevertheless, it is advisable to continue to pay attention to the own liver health even after the hospital stay. The liver is a detoxification organ. In order not to burden them unnecessarily, as few toxins as possible should be absorbed. Alcohol, nicotine, too fatty and too sweet food are as taboo as the indiscriminate use of medication. Even over-the-counter remedies can burden the liver.
Naturopaths recommend for liver detoxification to drink a lot of green tea, because it is supposed to dissolve fat in the liver and to be able to dissipate it. Artichokes are also considered to be liver protectants. Detoxification measures additionally relieve the liver. Everything that sweats is recommended, such as sauna, steam baths or sports. Even foods have a detoxifying effect. Curcuma, a curry spice, is intended to promote detoxification. But asparagus and water-rich fruit help flush out unnecessary toxins in the body.