Intended for healthcare professionals

Endgames Case Review

Deranged liver function in pregnancy

BMJ 2021; 372 doi: (Published 31 March 2021) Cite this as: BMJ 2021;372:n645
  1. Afra Jiwa, fourth year medical student1,
  2. Adam D Jakes, academic clinical fellow in obstetrics and gynaecology2,
  3. Anita Banerjee, obstetric physician2
  1. 1King’s College Medical School, London, UK
  2. 2Guy’s and St Thomas’ Hospital NHS Trust, St Thomas’ Hospital, London, UK
  1. Correspondence to: A D Jakes a.jakes{at}

A 26 year old Black African woman attended the emergency department at 11 weeks and three days’ gestation into her second pregnancy with persistent daily vomiting over the past five weeks and associated lower abdominal pain. She had been taking paracetamol 1 g four times daily over the past four weeks for ongoing tension-type headaches. Table 1 shows baseline observations and observations taken at her first midwife appointment at 10 weeks. Her body mass index (weight (kg)/(height (m)2)) was 16.9. On examination, she was clinically dehydrated and her mucous membranes were dry. Her abdomen was soft and non-tender and her liver was not palpable. The rest of the clinical examination was unremarkable. The results of urine analysis were within normal range. Blood test results showed deranged liver function (table 2). She had no history of alcohol misuse, recreational drug use, or foreign travel.

View this table:
Table 1

Observations at first midwife appointment and on presentation at …

View Full Text

Log in

Log in through your institution


* For online subscription