Treatment Options For Acute Fatty Liver Of Pregnancy

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• Once the mother is stabilized safe delivery is the key to recovery 6, 1
• Vaginal birth is best if possible
• Caesarean birth is performed if the mother’s condition is deteriorating
• During the postpartum period, patients are at high risk of bleeding and coagulopathy
○ Transfusion of blood products may be needed
○ Patients may be at risk for pancreatitis
– Screening serum lipase and amylase will be needed for several days
○ In majority of cases delivery of the infant with supportive care allows the recovery of the mother from liver failure
○ Symptoms may resolve naturally in 3-4 days 10
○ In some women there may be a long cholestatic phase, requiring approximately 4 weeks for recovery 6
○ Liver
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acute lung injury and adult respiratory distress syndrome
○ Symptomatic cardiovascular support
– Maintain mean arterial pressure >75 mm Hg
– Monitor volume replacement, norepinephrine infusion, hydrocortisone, and possibly, vasopressin
○ Treatment of coagulopathy
– Intravenous vitamin K
– Multiple transfusions of blood products, cryoprecipitate, fibrinogen, and platelets may be required
– Intravenous bolus of recombinant activated factor VIIa may be helpful
○ Electrolytes, blood sugar
– Monitor of serum electrolytes once or twice daily and supplement as needed to avoid hyponatremia
– Frequent monitoring of serum blood glucose
– Parenteral fluids containing 5% glucose for several days
○ Continuous hemodialysis
– To prevent intracranial pressure especially in hemodynamically unstable patients
• Comorbidities
○ Chronic hypertension prior to pregnancy or during the first 20 weeks 15
– Monitor the occurrence of preeclampsia, intrauterine growth restriction and placental abruption
– Women in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine
○ Gestational hypertension
– Pregnant women who develop hypertension after 20 weeks and do not have significant proteinuria
– Some of these women may develop proteinuria and thus preeclampsia

– Severe intrapartum or postpartum hypertension
– Systolic blood pressure is greater than or equal to 160 mm Hg or if diastolic measurement is
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