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Swansea Criteria for Acute Fatty Liver of Pregnancy (AFLP)

Six or more of the following features in the absence of another explanation:

    *Coagulopathy: Prothrombin > 14 seconds OR
           Activated Partial Thromboplastin Time > 34 seconds
    *Elevated transaminase (AST or ALT > 42 IU/L)
    *Elevated bilirubin > 14 umol/l (0.82 mg/dL)
    *Leukocytosis > 11 X 10^9 /L
    Abdominal pain
    Polydipsia/polyuria
    Encephalopathy
    Elevated ammonia > 47 umol/L
    Hypoglycemia < 4 mmol/l (72 mg/dL)
    Elevated urea > 0.34 mmol/l
    Ascites or bright liver on utrasound scan
    Renal impairment . Creatinine > 150 umol/L (1.7 mg/dL)
    MIcrovesicular steatosis on liver biopsy

    * Most frequent lab findings in AFLP [1]


Use of pregnancy-specific and/or laboratory-specific reference intervals is recommended.
An antithrombin III (ATIII) level of less than 65% may be helpful in distinguishing AFLP from hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome.


REFERENCE
1. Morton A, Laurie J. Physiological changes of pregnancy and the Swansea criteria in diagnosing acute fatty liver of pregnancy. Obstet Med. 2018 Sep;11(3):126-131. doi: 10.1177/1753495X18759353. Epub 2018 Apr 16. PMID: 30214478; PMCID: PMC6134352.

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