The patient is a 34 year-old G1P1 Caucasian female with
no medical history who was transferred from an outside
hospital after an emergent Cesarean section for increasing
jaundice with elevated liver enzymes, abnormal
coagulation times and acute renal failure. The patient
was healthy until 33 weeks gestation when she noted
dizziness, headache and visual changes. Blood pressure at
that time was elevated at 140/90 and she had trace lower
extremity edema. No proteinuria was detected. The
clinical picture was consistent with mild pre-eclampsia.
The patient was followed until 35 weeks gestation when
she developed vaginal bleeding and abdominal pain. At
that time, an emergency C-section was performed due
to a non-reassuring fetal heart rate. On the first night
after the surgery, she became anuric and laboratory tests
demonstrated acute renal failure, coagulopathy, and
elevated liver enzymes. She became progressively
jaundiced and she was transferred for further
management. On admission, she complained of nausea
and malaise. She denied abdominal pain, chest pain,
dyspnea, lightheadedness or headache.