Complications during pregnancy Quiz: Ace Your Exams

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A 35-year-old, gravida 2 para 1 at 34 weeks gestation, comes to the emergency department due to colicky abdominal pain, nausea and vomiting for the past day. She also feels generalized malaise and describes it as “more than usual.” The patient’s current pregnancy has been uncomplicated, other than an upper respiratory infection a week ago. Her first pregnancy was complicated by preeclampsia, which was managed with antihypertensive medications. The patient’s temperature is 37.0°C (98.6°F), pulse is 80/min, and blood pressure is 155/100 mmHg. On physical examination, right upper quadrant and epigastric tenderness are noted. The conjunctiva is pale and non-icteric. Laboratory results are shown below:

 Laboratory value  Result  Reference range 
 Hemoglobin  9 g/dL  12-16 g/dL 
 Platelet count  90,000/microL  150,000-400,000/microL 
 Glucose (random)  110 mg/dL  70-110 mg/dL 
 Bilirubin (total)  2.5 mg/dL  0.1-1 g/dL 
 Bilirubin (direct)  0.5 mg/dL   0-0.3 mg/dL 
 Aminotransferase (AST)  120 units/L  0-40 units/L 
 Lactate dehydrogenase, serum  600 units/L  45-90 units/L 
 Creatinine  1.10 mg/dL  0.6-1.2 mg/dL 
 Urine    
 Protein   +3  Negative 
 WBC   5/hpf  0-5/hpf 


Which of the following tests is most likely to assist in establishing the diagnosis?

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