A 32yo woman of 40wks gestation attends the antenatal day unit with sudden onset epigastric pain with nausea and vomiting. She is clinically jaundiced. Her biochemistry results show a raised bilirubin, abnormal liver enzymes, high uric acid and hypoglycemia. What’s the most likely dx?
a. Acute fatty liver of pregnancy
b. Obstetric cholestasis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis
Ans. The key is A. Acute Fatty Liver of Pregnancy. [When jaundice is present in pregnancy, AFLP should be high on the differential. Pain, nausea, vomiting, jaundice, fever with elevated liver enzymes and bilirubin is clinically indicative of AFLP. Also can have elevated INR, TLC and hypoglycaemia.