A 29-year-old woman at 34 weeks of gestation presents with nausea, vomiting, abdominal pain, and jaundice. Labs show total bilirubin 8.5 mg/dL, blood glucose 52 mg/dL, PT 22 seconds, ammonia 110 µmol/L, WBC 16,000/µL, and platelets 90,000/µL. Urine shows no proteinuria. Which diagnosis best explains this presentation?
- A HELLP syndrome
- B Intrahepatic cholestasis of pregnancy
- C Acute fatty liver of pregnancy ✓
- D Acute hepatitis E infection
Correct answer: C. Acute fatty liver of pregnancy
Explanation
Acute fatty liver of pregnancy (AFLP) typically presents in the third trimester with hypoglycemia, coagulopathy, encephalopathy, and elevated ammonia, reflecting microvesicular fatty infiltration of hepatocytes. It is associated with fetal deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD). HELLP syndrome features hemolysis, elevated liver enzymes, and low platelets with prominent hypertension and proteinuria. ICP causes pruritus and cholestasis without coagulopathy or hypoglycemia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.