MRCP2-0433

A 26-year-old primigravida presents to the emergency department with a 48-hour history of nausea and vomiting with associated right upper quadrant pain. She has no significant medical history and is only taking pregnancy vitamins. During her 33-week midwife appointment 2 weeks ago, it was noted that she had gained weight and had borderline hypertension. The decision at that appointment was to monitor.

Upon examination, she appears unwell and is clinically dehydrated. There are no significant findings on respiratory and cardiovascular examinations, but abdominal examination reveals a gravid uterus and right upper quadrant tenderness. Pitting edema is present up to the mid-shin. All observations are within normal limits except for a blood pressure of 145/90 mmHg. She is alert and oriented, denies any headaches, and has no rashes.

Blood tests are performed, and the results are as follows:

– Hb 100 g/L (Female: 115 – 160)
– Platelets 97 * 109/L (150 – 400)
– WBC 7.3 * 109/L (4.0 – 11.0)
– PT 13.0 seconds (9.5-13.5)
– APTT 39.0 seconds (30-40)
– Na+ 132 mmol/L (135 – 145)
– K+ 3.4 mmol/L (3.5 – 5.0)
– Bicarbonate 22 mmol/L (22 – 29)
– Urea 7.5 mmol/L (2.0 – 7.0)
– Creatinine 100 µmol/L (55 – 120)
– Bilirubin 45 µmol/L (3 – 17)
– ALP 150 u/L (30 – 100)
– ALT 350 u/L (3 – 40)
– Albumin 34 g/L (35 – 50)

An ultrasound of the abdomen shows patchy areas of hepatic enhanced echogenicity. Fetal monitoring is satisfactory, but the baby is in the breech position.

What is the most appropriate management for this patient, given the likely diagnosis?