Akute Schwangerschaftsfettleber – Fallserie einer seltenen Schwangerschaftskomplikation

Zusammenfassung

Die akute Schwangerschaftsfettleber (acute fatty liver in pregnancy, AFLP) ist mit einer Prävalenz von 0,01–0,03% eine seltene, potentiell lebensbedrohliche Komplikation in der Schwangerschaft. Durch die meist unspezifischen Symptome lässt sie sich schwer von anderen, teils häufigeren, Schwangerschaftserkrankungen wie HELLP Syndrom, aHUS und TTP abgrenzen. Ihre Seltenheit führt dazu, dass sie durch in der Geburtshilfe tätige Personen als Differentialdiagnose oft nicht in Erwägung gezogen wird. Dabei ist gerade die frühzeitige Diagnosestellung und schnellstmögliche Entbindung als einzige kausale Therapie entscheidend zur Verhinderung schwerwiegender Komplikationen und mütterlicher Todesfälle. In nachfolgender Arbeit wird anhand von Fallbeschreibungen dreier Uniklinika die Pathophysiologie, Bedeutung, Diagnose und Therapie der akuten Schwangerschaftsfettleber für die klinische Routine hervorgehoben und auf mögliche Befunde, welche in der Diagnosefindung zielführend sind, hingewiesen. Hierbei spielt auch der angiogene Präeklampsie-Marker sFlt-1 eine Rolle und bietet neue Betrachtungsweisen pathophsiologischer Ansätze.

Abstract

With a prevalence of 0,01-0,03%, acute fatty liver in pregnancy (AFLP) is a rare and dangerous complication of pregnancy and is difficult to distinguish from other, sometimes more common, pregnancy diseases such as HELLP syndrome, aHUS and TTP because of its mostly non-specific symptoms. Due to its rarity, AFLP is often not obvious to the obstetrician as a possible differential diagnosis. Yet early diagnosis and the fastest possible delivery is the only causal therapy and is important for the mortality rate. In the present manuscript, the pathophysiology, diagnosis and therapy of acute fatty liver in pregnancy are highlighted for the clinical routine based on case descriptions from three university hospitals, and reference is made to possible findings that are helpful in establishing the diagnosis. The angiogenic preeclampsia marker sFlt-1 plays a role and provides new opportunities to consider pathophysiological approaches.

Schlüsselwörter

Akute Schwangerschaftsfettleber (AFLP) - Schwangerschaftsspezifische Lebererkrankungen - Swansea-Kriterien - Unspezifisches Krankheitsgefühl in der Schwangerschaft

Key words

acute fatty liver of pregnancy (AFLP) - pregnancy-specific liver diseases - Swansea criteria - nonspecific feeling of illness in pregnancy

Publication History

Received: 02 October 2022

Accepted after revision: 03 May 2023

Article published online:
25 July 2023

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