Amber

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.

Select Relevant Investigations
FBC + Peripheral Smear

Performed

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

Performed

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

Performed

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

Performed

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)

Select Relevant Management
Urgent LSCS
Vitamin K
Induction of Labor
ICU Care