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Acute Fatty Liver of Pregnancy


Step 1: View clinicals

A 24 year old primipara in her 34th week of gestation presents with jaundice for 1 day, and nausea, vomiting and malaise for 4 days. She developed hypertension at 28 weeks, for which methyldopa was commenced. Her pregnancy was otherwise uneventful. The CTG shows a FHR of 158 bpm with reduced variability, one acceleration and no decelerations. An ultrasound abdomen shows a viable fetus, and a grade I fatty liver. Her urine tests negative for protein.

Step 2: Order all relevant investigations

FBC + Peripheral Smear

Hb: 11 g/dL (10.5-18) WBC: 10,400/mm3 (4,000-11,000) Platelets: 157,000/mm3 (150,000-400,000) Peripheral smear: no hemolysis

Liver Function Tests

ALT: 208 U/L (0-35) AST: 304 U/L (0-30) ALP: 532 U/L (35-135) Total Bilirubin: 8.3 mg/dL (0.1-1.2) Conjugated: 6.7 mg/dL Total Protein: 6 g/dL (6.0-8.3) Albumin: 2.6 g/dL (3.4-5.4) INR: 3.2 (0.9-1.1)

Hepatitis Serology

HBsAg: negative anti-HBc IgM: negative anti-HCV IgM: negative Hep-E antibodies: negative

Metabolic Panel

Blood Urea: 17 mg/dL (7-20) Serum Creatinine: 0.8 mg/dL (0.5-1.4) Glucose: 60 mg/dL Uric Acid : 5.3mg/dL (3.5-7.2) K+: 4.5 mEq/L (3.5-5.0) Na+: 138 mEq/L (135-145)

Step 3: Select appropriate management

Urgent LSCS
Vitamin K
Induction of Labor
ICU Care

Score: ★★☆