Physiological changes of pregnancy and the Swansea criteria in diagnosing acute fatty liver of pregnancy

Abstract

The Swansea criteria are used to assess the likelihood of acute fatty liver of pregnancy. There are significant physiological changes in normal pregnancy in several of the pathology parameters used in the Swansea criteria. This may impact the sensitivity and specificity of the Swansea criteria. Five of the 11 case series reporting laboratory values in acute fatty liver of pregnancy used values divergent from the Swansea criteria. When using the Swansea criteria for diagnosis of acute fatty liver of pregnancy, using pregnancy-specific and/or laboratory-specific reference intervals is recommended. Simpler diagnostic criteria using parameters of hepatocellular damage and hepatic synthetic dysfunction may be an alternative to the Swansea criteria, and further studies investigating the sensitivity and specificity of these parameters would be useful.

Accurate Prediction of Total PlGF (Placental Growth Factor) From Free PlGF and sFlt-1 (Soluble Fms-Like Tyrosine Kinase-1): Evidence for Markedly Elevated PlGF Levels in Women With Acute Fatty Liver of Pregnancy

“…The diagnosis of AFLP was suspected when a pregnant woman had symptoms of nausea, vomiting, fatigue, and anorexia at the end of the second or third trimester in combination with jaundice and elevated liver enzymes. The diagnosis of AFLP was confirmed when a woman fulfilled ≥6 out of 15 Swansea criteria, 13 and the treating physician found the clinical diagnosis of AFLP as most likely in comparison to other disorders, such as HELLP syndrome. Pregnancy characteristics and outcome were obtained from the digital medical files.…”

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

“…Maternal and fetal morbidity can be high for patients with AFLP (69, 70), however mortality rates have significantly declined over the past few decades from 85 to 10-17% (72,73). Diagnosing AFLP can be challenging if a patient also has preeclampsia or HELLP syndrome, but women who have at least six of the 15 Swansea criteria should be considered positive for AFLP as this criteria has been reported to have an 85% predictive value with 100% sensitivity for AFLP diagnosis (74,75). There have been few reported cases of AFLP recurring in women with a previous pregnancy complicated by AFLP.…”

Two Fatty Liver Conditions Masquerading as Autoimmune Hepatitis

“…roughout her hospitalization, INR ranged from 2.0 to 3.2 and she had seven hypoglycemic events (blood glucose < 70 mg/dL), even while tolerating a diet. Measurement of Case Reports in Hepatology low antithrombin III levels has been described as useful in diagnosing AFLP but was not tested in this patient [44]. Lastly, the patient had biopsy-confirmed microvesicular steatosis which does not occur in HELLP.…”