A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with
sudden onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam:
she is found to have RUQ tenderness. Her blood results show mild anemia, low platelets,
elevated liver enzymes and hemolysis. What is the most likely dx?
a. Acute fatty liver of pregnancy
b. Acute pyelonephritis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis
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answer: D
HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet count).
Incidence in pregnancy: 0.1–0.6%; in pre-eclampsia: 4–12%. It causes upper
abdo pain, malaise, vomiting, headache, jaundice, microangiopathic haemolytic
anaemia, DIC, LDH high, ALT high <500U/L, bilirubin <86μmol/L. It recurs in 20%.
Treatment: get expert help. Admit; deliver if severe.
acute fatty liver of pregnancy has pancreatitis, uremia and hypoglycemia
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