Having your baby

Once you have had your baby your liver should start to recover. So this needs to happen as soon as possible. About half of women have their baby early.

You need to be medically stable to have your baby safely.  Medically stable means your heart is beating and your blood pressure is in the normal range. You will probably still be very unwell and be having treatment to keep your liver and other organs working.

To deliver your baby safely, doctors will want to be sure that:

• Your blood is clotting normally
• Your blood sugar (glucose) is normal
• Your blood levels of key chemicals are normal and your blood isn’t too acidic (metabolic acidosis)

While you are being treated, doctors will plan how to deliver your baby quickly and safely. This will include both a liver specialist (hepatologist) and a pregnancy specialist (obstetrician). Their priority is your and your baby’s health.

Around a quarter of women with AFLP are only diagnosed after they have given birth. If this happens, you and your baby will be given any treatment you need as quickly as possible.

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Plasma exchange

Also called PLEX, therapeutic plasma exchange (TPE), and plasmapheresis.

If your liver is very badly damaged, plasma exchange might improve your condition and help you recover more quickly. It can also help keep you stable so you can have a liver transplant. You have plasma exchange after having your baby.

Plasma exchange is a blood treatment. It’s a bit like dialysis for kidney disease.

Your blood is made up of blood cells and a fluid called plasma. Plasma helps carry things around your body. This includes things you need like hormones. Plasma also carries toxins to the liver and kidneys so you can get rid of them in your pee and poo. In acute fatty liver of pregnancy your liver, and sometimes kidneys, are not working properly. So your body needs help to get rid of toxins.

Plasma exchange takes out your plasma along with the toxins. It is replaced with fresh plasma from a blood donor. You might have other things added to the plasma to help you recover, such as albumin.

Plasma exchange uses a machine called a blood cell separator. You will have a needle in each arm. These are connected to the blood cell separator by tubes. Your blood goes from one arm into the machine. It separates out your blood into the different parts – cells and plasma. Your plasma is taken away. Your blood cells and the fresh donor plasma flow back into your other arm.

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Medicines to treat liver damage

If you are admitted to intensive care you might be given a medicine called N-acetylcysteine (NAC) or Parvolex. It is used to help stop and repair liver damage in people who have taken a paracetamol overdose.

As acute fatty liver of pregnancy is so rare, there isn’t specific evidence that it helps protect your liver t. But it has been shown to help in other types of liver damage, not caused by paracetamol. It isn’t likely to be harmful.

N-acetylcysteine comes as a bag of fluid. You have it through a drip. You might need to have several bags.

Your doctor will talk to you and your family about your treatment and answer any questions.

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Liver transplant

A small number of women need a liver transplant after they have had their baby. This is medically called a transplant for fulminant liver failure. As with the other treatments, it needs to happen quickly.

If your doctors think you might need a transplant, they will start the initial checks as soon as possible. This is so they have as much time as possible to find a donor liver. Being listed for transplant doesn’t mean you will definitely have one. The doctors want to be ready just in case. Read more about having a liver transplant.

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