Abstract
Acute Liver Failure In Pregnancy
Highlights
Acute liver disease presenting as jaundice is a common event occurring in pregnancy occurring in about 1 per 1000 deliveries
[1] The great majority of viral hepatitidies are of slow onset and course
She presents with bulbar muscle dysfunction for 12 hours which she has had in the past. She has no other complaints except a decreased appetite for one day. Her pregnancy has been carefully followed because of a history of myasthenia gravis which has been intensively treated in the past and previous auto-immune thyroiditis neither presently active or requiring treatment for a year and a history of moderate to severe asthma which worsened during pregnancy for which she is taking moderate dose inhaled steroids twice a day, singulair once a day and a rescue inhaler required once a week or less
Summary
A 31 year G4 P3003 presents at 38 weeks with a 3-day history of icterus noticed by her husband but denied by the patient. The neurologist finds minimal but generalized muscle weakness except for bulbar muscles which are moderately weak and recommends resumption of her previous oral corticosteroid She receives IV corticosteroids because of two corticosteroid treatment courses in the last 6 months The patient’s laboratory workup has returned with the WBC is of 13,000 with slight eosinophilia, bands of 5% and metamyelocytes of 4%, a normal platelet size and morphology with a count of 317,000, a mild normochromic anemia consistent with her past values and no evidence of DIC, disseminated intravascular coagulation. The fetal ultrasound is normal with normal estimated fetal weight, normal amniotic fluid, a reactive NST, non-stress test, and normal Doppler of UA, umbilical artery flow, giving a modified biophysical of 4 of 4 Her liver shows a contracted gallbladder from a meal 2 hours previously but multiple calcified gallstones. Since she is term there is no reason to delay labor but no immediate need for an immediate cesarean section
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