A 37-Year-Old Woman, Gravida 2 Para 1, Comes to the Emergency

question 219

Multiple Choice

A 37-year-old woman, gravida 2 para 1, comes to the emergency department due to decreased fetal movement for the last 2 days.  She has had no contractions, vaginal bleeding, or leakage of fluid.  The patient had no issues with this pregnancy until a few weeks ago, when she began to develop generalized itching that is worse on her hands and feet.  She has also had nausea for the past 3 days but no vomiting or diarrhea.  The patient recently immigrated to the United States and has had no prenatal care.  Temperature is 37 C (98.6 F) and blood pressure is 134/76 mm Hg.  Fundal height is 38 cm.  There is no scleral icterus.  Cardiac and pulmonary examinations are normal.  The right upper quadrant is tender to palpation, but there is no rebound or guarding.  Bilateral lower extremities have 1+ pitting edema.  Diffuse excoriations are noted on the skin.  Laboratory results are as follows: A transabdominal ultrasound reveals a 38-week intrauterine gestation with no fetal cardiac activity.  Which of the following is the most likely cause of this patient's presentation?

• A)Acute fatty liver of pregnancy
• B)Acute viral hepatitis
• C)HELLP syndrome
• D)Intrahepatic cholestasis of pregnancy
• E)Preeclampsia with severe features

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