Bankstown Hospital - Grand Rounds - Further Reading

​​​​​Welcome to the Grand Rounds Further Reading List, Obstetrics and Gynaecology edition, brought to you by the Clinical Library, on Level 4, next to the Auditorium.

This library guide is to help support you in your professional development. Please give us feedback so we can improve this list in the future.

Some sections are under construction and will be ready later in the year. If you are presenting at a later Grand Rounds, please contact lynne.roberts3@health.nsw.gov.au and tell us about the content of your paper so we can add appropriate resources to the list for when you present your paper.

If you have any questions, please contact the Clinical Library on 9722 8250 or email SWSLHD-BankstownLibrary@health.nsw.gov.au or visit us Monday to Fridays, 8.30am - 5.00pm.

Cao, W., et al. (2022). "Timely identification and successful treatment of acute fatty liver of pregnancy without obvious clinical symptoms: Case reports." Medicine (Baltimore) 101(5): e28723 FULL TEXT @ URL https://journals.lww.com/md-journal/_layouts/15/oaks.journals/downloadpdf.aspx?an=00005792-202202040-00022

                RATIONALE: Acute fatty liver of pregnancy (AFLP) is a rare and potentially fatal complication that occurs in the third trimester or early postpartum period. The diagnosis of AFLP is based on typical clinical and laboratory features and imaging examinations. PATIENT CONCERNS: Case 1: a 25-year-old pregnant woman was hospitalized for threatened preterm birth at gestation of 35weeks and 2 days gestation. Laboratory tests revealed liver dysfunction, coagulopathy, hypoglycemia, hypoproteinemia, leukocytosis, and elevated creatinine and uric acid levels. Case 2: a 28-year-old (nulliparous) became pregnant after in vitro fertilization-embryo transfer at 29 weeks and 1 days' gestation and came to the obstetric ward for vaginal bleeding. At 34 weeks and 1 day, laboratory investigations showed high serum creatinine, uric acid, liver dysfunction, coagulopathy, and hypoglycemia. DIAGNOSES: Two patients did not show obvious clinical symptoms, while the ultrasound findings confirmed a diagnosis of AFLP. INTERVENTIONS: Immediate delivery and comprehensive supportive treatment are the most important methods for the treatment of AFLP. OUTCOMES: The 2 patients and their babies were discharged from the hospital in a good condition. LESSONS: Special attention should be paid to mothers with AFLP after in vitro fertilization-embryo transfer. The clinical presentation of AFLP is variable, hence laboratory features and ultrasound examination may be important methods for screening for AFLP.

Li, L., et al. (2023). "The assessment in patients with acute fatty liver of pregnancy (AFLP) treated with plasma exchange: a cohort study of 298 patients." BMC Pregnancy and Childbirth 23(1): 171 FULL TEXT AVAILABLE @ SWSLHD LIBRARIES https://doi.org/10.1186/s12884-023-05503-x

                To assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE).

Naothavorn, W., et al. (2022). "A 24-Year-Old Woman Presenting in the Third Trimester of Pregnancy with Nausea, Vomiting, and Abdominal Pain and Diagnosed with Acute Fatty Liver of Pregnancy." Am J Case Rep 23: e937085 FULL TEXT @ URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9423005/

                BACKGROUND Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency that most commonly occurs in the third trimester and has high mortality rates for the mother and fetus. AFLP is a diagnosis of exclusion supported by identifying 6 or more of the 15 Swansea criteria. This report is of a 24-year-old woman presenting in the third trimester of pregnancy with nausea, vomiting, and abdominal pain and diagnosed with AFLP. CASE REPORT A 24-year-old woman presented at 36 weeks of gestation with nausea, vomiting, and abdominal pain. Investigations showed leukocytosis, hyperbilirubinemia, increased liver enzymes, hypoglycemia, hyperuricemia, acute kidney injury (AKI), and coagulopathy. Ten of the 15 Swansea criteria were fulfilled. An emergency cesarean section resulted in the delivery of a healthy infant, followed by a normalization of the mother's liver function. Because long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the infant can be associated with maternal AFLP, genotyping of the infant was planned. CONCLUSIONS This report has shown the importance of clinical awareness, rapid diagnosis, and management of AFLP. Screening for fetal LCHAD deficiency could help decrease mortality.

Ramanathan, R. and J. A. Ibdah (2022). "Mitochondrial Dysfunction and Acute Fatty Liver of Pregnancy." International Journal of Molecular Sciences 23(7): 3595 FULL TEXT AVAILABLE @ URL https://www.mdpi.com/1422-0067/23/7/3595

               The liver is one of the richest organs in mitochondria, serving as a hub for key metabolic pathways such as β-oxidation, the tricarboxylic acid (TCA) cycle, ketogenesis, respiratory activity, and adenosine triphosphate (ATP) synthesis, all of which provide metabolic energy for the entire body. Mitochondrial dysfunction has been linked to subcellular organelle dysfunction in liver diseases, particularly fatty liver disease. Acute fatty liver of pregnancy (AFLP) is a life-threatening liver disorder unique to pregnancy, which can result in serious maternal and fetal complications, including death. Pregnant mothers with this disease require early detection, prompt delivery, and supportive maternal care. AFLP was considered a mysterious illness and though its pathogenesis has not been fully elucidated, molecular research over the past two decades has linked AFLP to mitochondrial dysfunction and defects in fetal fatty-acid oxidation (FAO). Due to deficient placental and fetal FAO, harmful 3-hydroxy fatty acid metabolites accumulate in the maternal circulation, causing oxidative stress and microvesicular fatty infiltration of the liver, resulting in AFLP. In this review, we provide an overview of AFLP and mitochondrial FAO followed by discussion of how altered mitochondrial function plays an important role in the pathogenesis of AFLP.