Preeclampsia presenting as liver pain and tenderness

Carolyn had an uncomplicated first pregnancy until she was 35 weeks 6 days gestation (pregnancy).

She phoned the Birth Unit as she had pain in her right upper abdomen.  She was asked to come in to be assessed. I attended to see her. She was slightly tender in the right upper abdomen and her blood pressure was mildly elevated at 140/90. There was 1+ protein in her urine on dipstick testing. A preeclampsia work-up was done and teh results came back as abnormal. The results were consistent with preeclampsia with liver involvement (elevated liver enzymes) and a mild thrombocytopenia (low platelet count). Her right upper abdomen discomfort was due to liver swelling with the preeclampsia.

She had two doses of steroid injection 12 hours apart to mature baby’s lungs, as I would need to deliver her baby soon because of the severity of the preeclampsia. It posed a significant health threat to Carolyn. I also commenced Carolyn on a blood pressure (antihypertensive) medication. Once she commenced on the antihypertensive medication not only did her blood pressure return to a normal level but also the liver discomfort ceased.

Labour was induced the next morning when she was 36 weeks 0 days gestation. Baby’s heart rate pattern became abnormal when she was 4 cm dilatation. I attended. The abnormal change settled after the Syntocinon infusion ceased. Despite a minimal Syntocinon infusion rate she progressed quickly and within the next hour her cervix was fully dilated. I was called. The baby heart rate pattern had become abnormal again consistent with foetal distress. Because of the foetal distress I used the MityOne vacuum cup to deliver her baby. Baby was born in good condition. Baby had a birth weight of 2530gms There was a small perineal tear which I sutured. The total duration of labour was estimated to be about 4 hours.

Carolyn’s postnatal recovery was uneventful. He antihypertensive medication was ceased. Her liver enzyme levels and platelet count returned to normal. Carolyn’s baby needed to be admitted to the Special Care Baby Unit because of prematurity issues. There was no hyaline membrane disease (immature lungs) concern. Mother and baby both have been discharged home.

Preeclampsia is one of the most serious complications of pregnancy. It is unusual to be first diagnosed as liver pain and tenderness. Carolyn’s blood pressure was normal, and her urine clear prior to the hospital admission. She not only had severe preeclampsia but of sudden onset. As such, there was likely to further rapid increased severity, which would be potentially life-threatening. It was very appropriate to expedite her delivery despite the premature gestation.

 

Posted by Dr Gary Sykes on - Latest Posts, Pregnancy and childbirth stories

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