I have been asked to put down some advice for couples who want to have more pregnancies after AFLP.
I am not a doctor, so the advice I give is from my own experience, and from information gathered on the net.
If you are planning a next pregnancy, I think first of all you want to think about where you want to have your baby. Personally, I have opted for the same Hospital and same Obstetrician. Her and her team know my file, and although things went wrong last time, I know they will really look after me and listen to every complaints I have. Not sure I would find that with another team who doesn't feel a bit of guilt at what happened to me last time (I know it's cheeky, but hey, whatever is best for my unborn child!). Another option is (if you can afford it) a private midwife. They usually are more receptive and have more time than overworked doctors and midwifes...
If you decide to go back to your previous Obstetrician, maybe contact him to let him know that you are trying for a baby and would like him to be your Obs again. See what he says.
On your first visit to him, come prepared, with a list of questions: what is the planned care, what specialists is he going to send you to, is he considering early delivery? Has he researched AFLP?
Care: you should get more appointments than the average pregnancy. Though the risks are greater in third trimester (and recurrence is very small), they should check your liver function and blood pressure more regularly as you approach and enter third trimester. And you should get more scans to check on the baby’s progress. A liver ultrasound might also be suggested (to check there is no fatty build up around the liver).
Specialists: The excessive thirst you might have experienced last time around was probably Diabetes Insipidus. So really, you should be referred to an Endocrinologist around 28 weeks to check on you. He will probably ask you questions about last time and maybe order a test. You can agree on a plan of action with him (prevention or as symptoms appear). You could also be referred to a Perinatologist.
Delivery: Your Obstetrician team might suggest an early delivery (36 – 37 weeks) as a precaution or if they are confident in their level of care then they might be considering caesarian only if symptoms appear.
Remember that YOU know best. If something is bothering you remind the staff that last time round YOU were the one to pay the price for not being given enough credit. It is going a stressful time for you and your family, but there is only a tiny chance at recurrence and this time round you’ll be on top of it. We still need to trust doctors and midwifes...
