Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy
Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Pr...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-01-01
|
| Series: | Case Reports in Obstetrics and Gynecology |
| Online Access: | http://dx.doi.org/10.1155/2017/5646247 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832549310929043456 |
|---|---|
| author | Maria Maldonado Ali Alhousseini Michael Awadalla Jay Idler Robert Welch Karoline Puder Manasi Patwardhan Bernard Gonik |
| author_facet | Maria Maldonado Ali Alhousseini Michael Awadalla Jay Idler Robert Welch Karoline Puder Manasi Patwardhan Bernard Gonik |
| author_sort | Maria Maldonado |
| collection | DOAJ |
| description | Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT) of 117.8 seconds, International Normalized Ratio (INR) of 10.34, and elevated transaminases suggestive of intrahepatic cholestasis of pregnancy. Her serum vitamin K level was undetectable (<0.1 nMol/L). Initial therapy consisted of intramuscular replacement of vitamin K and administration of fresh frozen plasma. Her hematuria and preterm labor resolved and she was discharged. She presented in active labor and delivered at 27 weeks and 1 day. Her bile acids (93 μ/L) and INR (2.32) had worsened. She delivered a male infant, 1150 grams with Apgar scores 7 and 9. The newborn received 0.5 mg of intramuscular vitamin K shortly after delivery but went on to develop bilateral grade III intraventricular hemorrhages by day 5. Intrahepatic cholestasis in pregnancy and nutrition issues were identified as the main risk factors for the severe coagulopathy of this patient. This case underlines the importance of evaluation of possible severe coagulopathy in patients with intrahepatic cholestasis of pregnancy in order to avoid serious maternal or fetal adverse outcomes. |
| format | Article |
| id | doaj-art-7ad184e665b7476282ba87ee155f9824 |
| institution | Kabale University |
| issn | 2090-6684 2090-6692 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Obstetrics and Gynecology |
| spelling | doaj-art-7ad184e665b7476282ba87ee155f98242025-02-03T06:11:34ZengWileyCase Reports in Obstetrics and Gynecology2090-66842090-66922017-01-01201710.1155/2017/56462475646247Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and CoagulopathyMaria Maldonado0Ali Alhousseini1Michael Awadalla2Jay Idler3Robert Welch4Karoline Puder5Manasi Patwardhan6Bernard Gonik7Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USADepartment of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USAIntrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT) of 117.8 seconds, International Normalized Ratio (INR) of 10.34, and elevated transaminases suggestive of intrahepatic cholestasis of pregnancy. Her serum vitamin K level was undetectable (<0.1 nMol/L). Initial therapy consisted of intramuscular replacement of vitamin K and administration of fresh frozen plasma. Her hematuria and preterm labor resolved and she was discharged. She presented in active labor and delivered at 27 weeks and 1 day. Her bile acids (93 μ/L) and INR (2.32) had worsened. She delivered a male infant, 1150 grams with Apgar scores 7 and 9. The newborn received 0.5 mg of intramuscular vitamin K shortly after delivery but went on to develop bilateral grade III intraventricular hemorrhages by day 5. Intrahepatic cholestasis in pregnancy and nutrition issues were identified as the main risk factors for the severe coagulopathy of this patient. This case underlines the importance of evaluation of possible severe coagulopathy in patients with intrahepatic cholestasis of pregnancy in order to avoid serious maternal or fetal adverse outcomes.http://dx.doi.org/10.1155/2017/5646247 |
| spellingShingle | Maria Maldonado Ali Alhousseini Michael Awadalla Jay Idler Robert Welch Karoline Puder Manasi Patwardhan Bernard Gonik Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy Case Reports in Obstetrics and Gynecology |
| title | Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy |
| title_full | Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy |
| title_fullStr | Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy |
| title_full_unstemmed | Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy |
| title_short | Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy |
| title_sort | intrahepatic cholestasis of pregnancy leading to severe vitamin k deficiency and coagulopathy |
| url | http://dx.doi.org/10.1155/2017/5646247 |
| work_keys_str_mv | AT mariamaldonado intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT alialhousseini intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT michaelawadalla intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT jayidler intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT robertwelch intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT karolinepuder intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT manasipatwardhan intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy AT bernardgonik intrahepaticcholestasisofpregnancyleadingtoseverevitaminkdeficiencyandcoagulopathy |