We present clinical features and outcomes of second-trimester acute fatty liver of pregnancy (AFLP), a serious but rare condition. Fourteen pregnant women with AFLP or compatible biopsy were identified in the literature. Diagnosis occurred between 20 and 27 + 6 weeks of gestational age. In total, 50% were primigravid. Thirteen cases met the Swansea criteria while the other case had a compatible liver biopsy. In total, 10 out of 11 cases had microvesicular steatosis on their liver biopsy. Common maternal complications included acute renal failure, hypoglycaemia, liver failure, encephalopathy, intensive care unit admission and need for blood transfusions. Seven deliveries were on the day of diagnosis, five within four weeks, and two within three months. One maternal death, seven fetal deaths and three neonatal deaths occurred. AFLP diagnosed in the second trimester is a rare condition. Neonatal mortality and maternal morbidity are high. Most cases had nonspecific symptoms and clinical findings, but a majority had compatible biopsies.

It appears that some ABO blood groups may be a risk factor for venous thrombosis. The association between ABO group and risk of pre-eclampsia remains controversial. The purpose of this study was to evaluate the relationship between pre-eclampsia and ABO groups. A retrospective case-control (1:2) study in a prospective monocentric registry including 20171 pregnancies was performed. Women with pre-eclampsia and severe pre-eclampsia were identified. Controls were matched according to age, parity, year of delivery and body mass index. Blood groups were considered. Two hundred fifty-three cases and 506 controls were included. No difference in distribution was found between cases and controls for non-O group (57.51% vs 62.56, p: 0.19), group A (39.92% vs 44.05, p: 0.29), group B (13.83% vs 15.42, p: 0.57) group AB (3.75 vs 3.08, p: 0.64). The analysis extended to severe pre-eclampsia showed no difference. This study did not document any relationship between ABO groups and the risk of preeclampsia.

Congenital thrombocytopenia results from mutations in genes implicated in megakaryocyte differentiation and/or platelet formation and clearance. We report the case of a 25 year old primigravida who presented with severe macro-thrombocytopenia from the age of 12 years. She delivered an alive female baby at 35 weeks of gestation. She was diagnosed to have GNE gene mutation. GNE gene encodes the key enzyme in sialic acid biosynthesis, glucosamine (UDP-N-acetyl)-2-epimerase/N-acetylmannosamine kinase (GNE/MNK). The mutation is responsible for the reduction in sialic acid biosynthesis and consequently leads to severe congenital thrombocytopenia and/or myopathy. Although no sign of myopathy was observed in this patient; it is possible myopathy can be developed later, thus long-term follow-up with neurology is highly advisable. We recommend the genetic counselling and a segregation analysis of this variant in other affected individuals in the family.

Whilst uncommon in pregnancy, hypercalcaemia can lead to significant maternal and fetal morbidity. An important complication of hypercalcaemia is uncontrolled hypertension. This case outlines an example of refractory hypercalcaemia exacerbating an emerging hypertensive crisis. The proposed aetiology was parathyroid hormone-related protein (PTHrP)-mediated hypercalcaemia secondary to a necrotic uterine fibroid. We highlight how effective and prompt involvement of the Maternal Medicine Network and multidisciplinary team led to a successful pregnancy outcome.

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic pregnancy complication. This is a 10-year retrospective study on women with AFE from 2014 to 2023. Cases that met Clark's criteria or in whom a clinical diagnosis was made after exclusion of other causes were included. Information on clinical characteristics, treatment, complications and outcomes were collected and analysed. Four cases of AFE were identified. Two met Clark's criteria and presented with cardiac arrest requiring extracorporeal membrane oxygenation, of which one had cognitive and functional impairment. Two women had atypical AFE, one with disseminated intravascular coagulation (DIC)-type AFE who did not survive, and another who had paradoxical intracranial emboli from a patent foramen ovale, who had full recovery. All had coagulopathy and postpartum haemorrhage. Early recognition and initiation of cardiovascular support is crucial in AFE. DIC and haemorrhage should be treated aggressively. Survival and good outcomes of AFE are possible.