Treatment Options For Acute Fatty Liver Of Pregnancy

TREATMENT OPTIONS †¢ 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 ââ€"‹ Transfusion of blood products may be needed ââ€"‹ Patients may be at risk for pancreatitis – Screening serum lipase and amylase will be needed for several days ââ€"‹ In majority of cases delivery of the infant with supportive care allows the recovery of the mother from liver failure ââ€"‹ Symptoms may resolve naturally in 3-4 days 10 ââ€"‹ In some women there may be a long cholestatic phase, requiring approximately 4 weeks for recovery 6 ââ€"‹ Liver†¦show more content†¦acute lung injury and adult respiratory distress syndrome ââ€"‹ Symptomatic cardiovascular support – Maintain mean arterial pressure 75 mm Hg – Monitor volume replacement, norepinephrine infusion, hydrocortisone, and possibly, vasopressin ââ€"‹ 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 ââ€"‹ 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 ââ€"‹ Continuous hemodialysis – To prevent intracranial pressure especially in hemodynamically unstable patients †¢ Comorbidities ââ€"‹ 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 ââ€"‹ 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