Approach to hypertensive disorders in pregnancy Quiz: Ace Your Exams

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A 23-year-old primigravid woman, at 36 weeks of gestational age, presents to Labor and Delivery triage with severe right upper quadrant abdominal pain and a headache that has been getting progressively worse over the last 12 hours. She also has mild nausea without vomiting and feels generally unwell. Past medical history is noncontributory, and her only medication is a prenatal vitamin. Temperature is 36.5°C (97.7°F), pulse is 86/min, respirations are 18/min, and blood pressure is 148/86 mmHg. On exam, the lungs are clear to auscultation, severe tenderness is noted in the right upper quadrant and epigastric regions, and patellar reflexes are 3+ bilaterally. The fetal heart rate pattern is reassuring, and there are no contractions on maternal-fetal cardiotocographic monitoring. Labs results are shown in the table below.  Which of the following is the most likely diagnosis? 

 Laboratory value     Result   
 Serum chemistry    
 Hemoglobin      10.5 g/dL    
 Leukocyte count     6,100/µL    
 Platelet count     90,000/µL    
 Sodium      143 mEq/L    
 Potassium      4.2 mEq/L    
 Chloride      95 mEq/L    
 Creatinine (Cr)     1.3 mg/dL    
 Alanine aminotransferase (ALT)     84 IU/L    
 Aspartate aminotransferase (AST)     98 IU/L    
 Lactate dehydrogenase (LDH)     750 IU/L    
 Urinalysis   
 Color     Clear    
 Specific gravity     1.013    
 Glucose     negative    
 Blood     negative    
 Protein     negative    
 Leukocyte esterase     negative    
 Nitrites     negative    

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