Her liver enzymes are raised and her other blood results are as follows:

A 31 year old woman who is currently 39 weeks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain associated with nausea and vomiting. She has a temperature of 36.7°C and her blood pressure is 155/100 mmHg. Her liver enzymes are raised and her other blood results are as follows:

Haemoglobin 82 g/L White cell count 5 x 109/L Platelets 90 x 109/L

What is the SINGLE most likely diagnosis?

A. Acute fatty liver of pregnancy
B. Acute pyelonephritis
C. Cholecystitis
D. HELLP syndrome
E. Acute hepatitis

HELLP syndrome
complication regarded by most as a variant of severe pre-eclampsia which manifests with haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Liver enzymes usually increase and platelets decrease before haemolysis occurs. The syndrome is usually self-limiting, but permanent liver or renal damage may occur. Note that eclampsia may co-exist. Signs and Symptoms: • Epigastric or RUQ pain and tenderness • Nausea and vomiting • Urine is ‘tea-coloured’ due to haemolysis. • Increased BP and other features of pre-eclamsia Management • Delivery • Supportive and as for eclampsia (magnesium sulfate (MgSO 4 ) is indicated) • Although platelet levels may be very low, platelet infusions are only required if bleeding, or for surgery and <40