Jaundice and pregnancy

A 25‐year‐old woman presented with jaundice, vomiting and weight loss. She was 13 weeks’ pregnant (gravida 2, para 1) and had lost 20 kg (from 85 kg to 65 kg) over the course of the pregnancy. She had first noticed the jaundice 3 weeks earlier. She denied abdominal pain and pruritus. In a previous pregnancy she had hyperemesis gravidarum and lost 30 kg during the first trimester. She denied any other medical history. She was taking ondansetron as required for her nausea but denied taking any other medications, herbal remedies or over‐the‐counter products. She did not drink alcohol. Her vital signs at presentation were: blood pressure in the sitting position 109/70 mmHg, blood pressure in the standing position 90/68 mmHg, respiratory rate 18 breaths per minute and oxygen saturation 98%, and she was afebrile. She was clinically dehydrated, as evidenced by postural hypotension and dry mucous membranes, which was further supported by ketones present on bedside urinalysis. She was visually jaundiced but, notably, her abdomen was soft and non‐tender, and there was no evidence of hepatosplenomegaly or peripheral stigmata of chronic liver disease. Pertinent blood test results are shown in Box 1.