title: Noninvasive Swansea criteria are valuable alternatives for diagnosing acute fatty liver of pregnancy in a Chinese population.
abstract: BACKGROUND
  This study aims to assess the diagnostic and prognostic value of Swansea criteria in diagnosing acute fatty liver of pregnancy (AFLP) in a Chinese population.
  
  
  METHODS
  A retrospective study was conducted on 52 Chinese women diagnosed with AFLP. All selected cases were reassessed using the Swansea criteria with special focus on the noninvasive criteria, since performing a liver biopsy for this indication is rare in a Chinese population.
  
  
  RESULTS
  Ninety point four percent of patients fulfilled five or more of the Swansea criteria. Thirty-one cases were positive for six or more Swansea criteria, but there were no significance differences between patients when using a cutoff criteria <6 or >6. When patients were positive for less than seven criteria, frequency of stillbirth, continuous blood purification (CBP) treatment, hysterectomy, and postpartum hemorrhage were not increased. However, patients who were positive for seven or more criteria had a significantly higher risk of stillbirth and a higher rate of CBP treatment (p < 0.05). Areas under the receiver operating characteristic (ROC) curve of postpartum hemorrhage was 0.670, which reached a statistical significance (p = 0.040). We observed a significantly elevated postpartum hemorrhage along with positivity of the Swansea criteria (p = 0.040).
  
  
  CONCLUSIONS
  Swansea criteria without liver biopsy are good screening tools for AFLP diagnosis, and may be useful for assessing disease severity.
authors.affiliation: a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China.
authors.forename: Shan
authors.initials: S
authors.lastname: Wang
authors.affiliation: b Department of Obstetrics and Gynecology , Shandong Provincial Maternity and Childcare Hospital , Jinan , China.
authors.forename: Shan-Ling
authors.initials: SL
authors.lastname: Li
authors.affiliation: a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China.
authors.forename: Yan-Xia
authors.initials: YX
authors.lastname: Cao
authors.affiliation: a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Li
authors.affiliation: a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China.
authors.forename: Jin-Lai
authors.initials: JL
authors.lastname: Meng
authors.affiliation: a Department of Obstetrics and Gynecology , Shandong Provincial Hospital affiliated to Shandong University , Jinan , China.
authors.forename: Xie-Tong
authors.initials: XT
authors.lastname: Wang
mesh_terms: D000328:Adult; D002681:China; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008111:Liver Function Tests / Q000379:methods; D008516:Medicine, Chinese Traditional / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Acute fatty liver of pregnancy; Swansea criteria; diagnose; noninvasive