Preeclampsia with severe features — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardPregnancy ComplicationsPreeclampsia with severe featuresMCCQE Part 1

At 36 weeks, a patient develops vomiting, jaundice, confusion, hypoglycemia, elevated transaminases, prolonged INR and acute kidney injury. Blood pressure is normal and ultrasound shows no obstruction. What is the best management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stabilize the patient and expedite delivery

Late-pregnancy vomiting, jaundice, encephalopathy, hypoglycemia, coagulopathy and renal dysfunction strongly suggest acute fatty liver of pregnancy. Stabilize airway and circulation, correct hypoglycemia and coagulopathy, involve maternal-fetal medicine, anesthesia, critical care and hepatology, and expedite delivery once resuscitation is underway. Delivery removes the pregnancy trigger and must not await biopsy. Continue intensive monitoring afterward because hepatic failure can initially progress; transplant-centre consultation is warranted if recovery fails. HELLP more often features hypertension, hemolysis and thrombocytopenia, whereas marked hypoglycemia and synthetic liver failure favour acute fatty liver. Ursodiol treats cholestatic disorders but not this emergency.

Reference: FIGO liver disease and pregnancy guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC8475247/