2026 SOAP Annual Meeting

Background and Hypothesis

•Acute fatty liver of pregnancy (AFLP) is a rare, life-threatening obstetric emergency characterized by acute hepatic failure in late pregnancy or the early postpartum period

•AFLP is associated with hepatic dysfunction, metabolic derangements, and coagulopathy, contributing to multi-system organ involvement

•Patients may develop complications including renal injury, encephalopathy, and hemodynamic instability, all of which complicate peripartum management

•Given the liver’s central role in coagulation and metabolism, AFLP presents a unique risk for both hemorrhagic and systemic complications

•However, population-level data characterizing the full spectrum of morbidity and mortality in AFLP remains limited

Objective:
To evaluate maternal morbidity and mortality outcomes in AFLP patients compared to normal pregnancies

Hypothesis:
AFLP is associated with increased multi-system morbidity and mortality, including hepatic, renal, and hematologic complications

Study Design and Methods

•Retrospective cohort analysis using the TriNetX Global Collaborative Network

•Population: Peripartum women diagnosed with AFLP

•Comparison: AFLP vs normal pregnancy population

Primary outcome:

•Postpartum hemorrhage (PPH)

Secondary outcomes:

•Hepatic: portal hypertension, encephalopathy, acute pancreatitis, hypoproteinemia

•Renal: acute kidney injury (AKI), acute renal failure

•Hematologic: coagulopathy

Mortality

Statistical analysis:

•Hazard ratios (HR) with 95% confidence intervals

•Kaplan–Meier survival analysis

•Cohorts standardized after baseline matching

Discussion & Conclusion

•Patients with AFLP had significantly higher multi-system morbidity and mortality
– ↑ postpartum hemorrhage (PPH)
– ↑ hepatic complications (portal hypertension, pancreatitis, encephalopathy, hypoproteinemia)
– ↑ renal complications (AKI, acute renal failure)
– ↑ coagulopathy
– ↑ mortality

•• All outcomes demonstrated statistically significant increases compared to normal pregnancy

•• Clinical interpretation: AFLP represents a severe multi-organ disease process driven by hepatic dysfunction, leading to widespread metabolic, hematologic, and end-organ complications

•• Implications: Supports the need for early recognition, multidisciplinary management, and close peripartum monitoring, particularly for coagulopathy and end-organ dysfunction

•• Limitations: retrospective design, reliance on ICD coding, limited granularity on timing/severity of disease

•• Future directions
– Larger multicenter studies to further characterize disease severity and progression
– Prospective studies evaluating timing of intervention and anesthetic management strategies
– Development of clinical risk stratification and management algorithms for AFLP patients

2026 SOAP Annual Meeting

Acute Fatty Liver of Pregnancy Increases Postpartum Hemorrhage and ICU Admission: Implications for Peripartum Anesthesia

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