AFLP at 34 weeks — emergency-management and communication station

Resuscitation station: a third-trimester woman with AFLP. The candidate must recognise the Swansea criteria, run the supportive bundle, mobilise the team, and deliver — all while communicating with a frightened partner. Includes assessor key, marking domains and fail criteria.

Prompt

A 30-year-old primigravida at 34 weeks is referred to labour ward triage by her GP with three days of vomiting and right-upper-quadrant pain. She is drowsy but rousable, BP 108/66, HR 102. Bedside bloods return within 30 minutes: glucose 2.0 mmol/L, INR 2.1, fibrinogen 1.4 g/L, ALT 240 IU/L, bilirubin 50 micromol/L, ammonia 110 micromol/L, urate 0.45 micromol/L, creatinine 130 micromol/L, leucocytes 17, platelets 220. CTG is reactive. You are the obstetric registrar; the consultant is in theatre and will be 20 minutes.

Station brief

Format. Resuscitation station, approximately 12 minutes. You are the obstetric registrar on labour ward. The candidate plays the registrar; the assessor plays the midwife, the partner and the consultant (via phone). Real-time management:ABCDE-style stabilisation, diagnostic call, definitive plan, communication.^[2]

Candidate instruction. Take handover from the midwife, assess and stabilise the patient, make the diagnosis, mobilise the team, decide on delivery, and counsel the partner. The consultant is 20 minutes away and will expect a structured handover when she arrives.^[1]

References4Show

[1]Ch'ng CL, Morgan M, Hainsworth I, Kingham JG Prospective study of liver dysfunction in pregnancy in Southwest Wales Gut, 2002.PMID 12427793
[2]Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P; UK Obstetric Surveillance System A prospective national study of acute fatty liver of pregnancy in the UK Gut, 2008.PMID 18332072
[3]Westbrook RH, Yeoman AD, Joshi D, Heaton ND, Quaglia A, O'Grady JG, Auzinger G, Bernal W, Heneghan MA, Wendon JA Outcomes of severe pregnancy-related liver disease: refining the role of transplantation Am J Transplant, 2010.PMID 20977643
[4]Liu J, Ghaziani TT, Wolf JL Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management Am J Gastroenterol, 2017.PMID 28291236

AFLP at 34 weeks — emergency-management and communication station

Station brief

References4Show

[1]Ch'ng CL, Morgan M, Hainsworth I, Kingham JG Prospective study of liver dysfunction in pregnancy in Southwest Wales Gut, 2002.PMID 12427793
[2]Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P; UK Obstetric Surveillance System A prospective national study of acute fatty liver of pregnancy in the UK Gut, 2008.PMID 18332072
[3]Westbrook RH, Yeoman AD, Joshi D, Heaton ND, Quaglia A, O'Grady JG, Auzinger G, Bernal W, Heneghan MA, Wendon JA Outcomes of severe pregnancy-related liver disease: refining the role of transplantation Am J Transplant, 2010.PMID 20977643
[4]Liu J, Ghaziani TT, Wolf JL Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management Am J Gastroenterol, 2017.PMID 28291236