Multivalvular infective endocarditis in pregnancy presenting with septic pulmonary emboli.

A 33-year-old woman presented at 36 weeks gestation with worsening respiratory distress. A CT-pulmonary angiogram was performed to rule out a massive pulmonary embolism; instead, this identified extensive septic pulmonary emboli throughout both lung fields. Given the continuing maternal deterioration, a non-elective caesarean section was performed. A transoesophageal echocardiogram identified multiple large cardiac valve vegetations on both sides of her heart with an associated aortic root abscess. She responded well to a 6-week course of intravenous antibiotics.

Acute fatty liver of pregnancy with hypoglycaemia, diabetes insipidus and pancreatitis, preceded by intrahepatic cholestasis of pregnancy.

We present the case of a 33-year-old woman in her first pregnancy. She presented with pruritus at 34 weeks gestation. A diagnosis of intrahepatic cholestasis of pregnancy was made based on elevated bile acids and elevated liver transaminases. She re-presented 4 days later, jaundiced with abdominal pain and nausea, and was hypertensive. Her bilirubin was now elevated and her creatinine had doubled. The differential diagnosis-included pre-eclampsia and Hemolysis Elevated Liver enzymes Low Platelet count (HELLP) syndrome, and delivery was expedited. Postnatally, the patient became coagulopathic, though not thrombocytopaenic; she had persistent hypoglycaemia, hyponatraemia, developed acute pancreatitis and had profound ascites and peripheral oedema. Management was supportive with multidisciplinary care and over a period of 3 weeks she made a full clinical and biochemical recovery.