A 30-year-old primigravida at 36 weeks gestation presents with nausea, vomiting, jaundice, and right upper quadrant pain. Laboratory studies show elevated transaminases (AST 450 U/L, ALT 480 U/L), hypoglycemia, and prolonged prothrombin time. Which is the definitive management?
- A IV N-acetylcysteine
- B Immediate delivery of the fetus ✓
- C Ursodeoxycholic acid
- D Plasma exchange
Correct answer: B. Immediate delivery of the fetus
Explanation
Acute fatty liver of pregnancy (AFLP) is a microvesicular fatty infiltration of hepatocytes occurring in the third trimester. It is associated with defects in mitochondrial fatty acid oxidation. The definitive treatment is immediate delivery of the fetus, after which the mother typically recovers. Delay in delivery can lead to fulminant hepatic failure and fetal death.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.