What are the guideline sources, guidelines and references for Acute fatty liver of pregnancy ?
Guideline sources The following summarized guidelines for the evaluation and management of acute fatty liver of pregnancy (AFLP) are prepared by our editorial team based on guidelines from the Chinese Society of Obstetrics Gynecology (CSOG 2021), the American Association for the Study of Liver Diseases (AASLD 2021), the American College of Gastroenterology (ACG 2016), and the Italian Association for the Study of the Liver (AISF 2016). 1 2 3 4 Guidelines 1. Screening and diagnosis Indications for screening: Obtain prenatal screening for AFLP in outpatients at 35-37 weeks of gestation. B Obtain routine blood tests, liver function, and coagulation function as first-line screening indicators. Obtain testing immediately in pregnant patients with gastrointestinal symptoms, such as nausea and vomiting, and suspected AFLP. B https://web.pathway.md/diseases/recKyH4P0mQaY6BKV 1/4 6/23/23, 1:44 AM Acute fatty liver of pregnancy Pathway Obtain retesting within 24 hours to identify AFLP as soon as possible in patients with suspected AFLP based on initial screening. B Diagnosis: As per AASLD 2021 guidelines, diagnose AFLP based on clinical and laboratory parameters, and rarely liver biopsy. E As per CSOG 2021 guidelines: Use the Swansea criteria for diagnosing AFLP. B Diagnose AFLP mainly based on clinical manifestations; liver biopsy is unnecessary. B 2. Classification and risk stratification Prognosis: Assess postoperative prothrombin activity, TBIL, platelet count, and serum creatinine as prognostic indicators. B Evaluate patients by a multidisciplinary team if the abovementioned indicators continue to be abnormal after delivery or the patient is not recovering by 1 week after delivery, and offer liver transplantation if the patient is suitable. B 3. Diagnostic investigations Abdominal imaging: obtain abdominal imaging to rule out hepatic hemorrhage, infarction, or rupture in patients with AFLP. Transfer patients with hepatic rupture or ALF promptly to a transplant center for evaluation. E Genetic testing: as per ACG 2016 guidelines, obtain molecular testing for long-chain 3- hydroxyacyl-CoA dehydrogenase in all patients with AFLP and their children. B 4. Medical management Supportive therapy: administer prompt supportive therapy in an intensive care setting to stabilize patients with AFLP. B 5. Inpatient care Serial laboratory assessment: obtain routine monitoring blood tests including glucose, liver function, kidney function, and coagulation function during the treatment period. B 6. Therapeutic procedures Liver support system: offer artificial liver treatment in patients with severe AFLP. B https://web.pathway.md/diseases/recKyH4P0mQaY6BKV 2/4 6/23/23, 1:44 AM Acute fatty liver of pregnancy Pathway 7. Perioperative care Preoperative risk assessment: use levels of prothrombin activity/INR, TBIL, platelet count, lactic acid, serum creatinine, and disease duration as indicators for preoperative risk assessment. B Show 3 more 8. Follow-up and surveillance Delivery: As per AASLD 2021 guidelines, perform expeditious delivery in patients with suspected AFLP after maternal stabilization. E As per CSOG 2021 guidelines, perform complete vaginal delivery, if vaginal delivery is inevitable, as soon as possible while improving coagulation function and preventing postpartum hemorrhage. B Show 3 more As per ACG 2016 guidelines, perform prompt delivery in patients with AFLP. B As per AISF 2016 guidelines: Ensure not exceeding one week interval from onset of AFLP to delivery. B Perform C-section when vaginal delivery cannot be achieved quickly in AFLP. B Newborn monitoring: As per AASLD 2021 guidelines, screen all newborns of mothers with AFLP at birth for long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency or other fatty acid oxidation defects. Refer affected families to genetic counseling. E As per ACG 2016 guidelines, obtain careful monitoring for manifestations of deficiency of long- chain 3-hydroxyacyl-CoA dehydrogenase including hypoketotic hypoglycemia and fatty liver in children born to mothers with AFLP. B References 1. Li, Ping, Chen et al. CSOG MFM Committee Guideline: Clinical Management Guidelines for Acute Fatty Liver of Pregnancy in China 2021 . Maternal-Fetal Medicine. 2021 Oct;3 4 238 245. Open 2. Monika Sarkar, Carla W Brady, Jaquelyn Fleckenstein et al. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73 1 318 365. Open 3. Tram T Tran, Joseph Ahn, Nancy S Reau. ACG Clinical Guideline: Liver Disease and Pregnancy. Am J Gastroenterol. 2016 Feb;111 2 176 94; quiz 196. Open 4. Italian Association for the Study of the Liver AISF , Italian Association for the Study of the Liver AISF. AISF position paper on liver disease and pregnancy. Dig Liver Dis. 2016 Feb;48 2 120 37. Open https://web.pathway.md/diseases/recKyH4P0mQaY6BKV 3/4 6/23/23, 1:44 AM Acute fatty liver of pregnancy Pathway 5. C L Ch'ng, M Morgan, I Hainsworth et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut. 2002 Dec;51 6 876 80. Open https://web.pathway.md/diseases/recKyH4P0mQaY6BKV 4/4