{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:40:03Z","timestamp":1756327203640,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,12]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>A woman in her fifth month of pregnancy presented to the outpatient department with vomiting, generalised itching and yellowish discolouration of the skin for 1\u2009week. No history of rashes, fever, pain abdomen or altered stools. In view of four pregnancy losses previously, she was evaluated to have antiphospholipid antibody syndrome and was advised low molecular weight heparin. She was a known type-II diabetic on insulin. Prophylactic oral dydrogesterone and natural micronised progesterone were started at a local hospital 2\u2009months prior, in view of threatened abortion. Investigations revealed grossly elevated serum bilirubin and liver enzymes. Other blood investigations were unremarkable and abdominal ultrasonography was normal. The most likely diagnosis in this case, is drug-induced liver injury due to oral progestin consumption. Causality assessment by Roussel Uclaf Causality Assessment Model was used to establish the diagnosis. High doses of progestin over a prolonged period resulted in acute hepatic toxicity causing itching, jaundice and transaminitis. Cautious use of progestins in appropriate dosage is recommended during pregnancy.<\/jats:p>","DOI":"10.1136\/bcr-2023-257138","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T12:50:25Z","timestamp":1708519825000},"page":"e257138","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Acute liver injury in pregnancy"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5836-7241","authenticated-orcid":false,"given":"Akshaya","family":"Murali","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riyamol","family":"Jose","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shobha","family":"Giliyar","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"2025082713044650000_17.2.e257138.1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.4254\/wjh.v13.i7.747","article-title":"Liver injury associated with drug intake during pregnancy","volume":"13","author":"Kamath","year":"2021","journal-title":"World J Hepatol"},{"key":"2025082713044650000_17.2.e257138.2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/cld.615","article-title":"Overview of causality assessment in drug-induced liver injury","volume":"9","author":"Hayashi","year":"2017","journal-title":"Clinical Liver Disease"},{"key":"2025082713044650000_17.2.e257138.3","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1097\/CM9.0000000000001821","article-title":"Swansea criteria score in acute fatty liver of pregnancy","volume":"135","author":"Tan","year":"2022","journal-title":"Chin Med J (Engl)"},{"key":"2025082713044650000_17.2.e257138.4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.14717","article-title":"FIGO good practice recommendations on the use of progesterone in the management of recurrent first-trimester Miscarriage","volume":"161 Suppl 1","author":"Shehata","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"2025082713044650000_17.2.e257138.5","doi-asserted-by":"crossref","first-page":"2896","DOI":"10.1136\/bmj.n2896","article-title":"NICE recommends progesterone to prevent early Miscarriage","volume":"375","author":"Wise","year":"2021","journal-title":"BMJ"},{"key":"2025082713044650000_17.2.e257138.6","unstructured":"Progestins . LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD). National Institute of Diabetes and Digestive and Kidney Diseases, 2012. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548237\/"},{"key":"2025082713044650000_17.2.e257138.7","doi-asserted-by":"crossref","DOI":"10.1002\/ccr3.5687","article-title":"Rare case of Norethisterone-induced hepatitis: A case report","volume":"10","author":"Arafa","year":"2022","journal-title":"Clin Case Rep"},{"key":"2025082713044650000_17.2.e257138.8","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jceh.2017.01.001","article-title":"Norethisterone related drug induced liver injury: A series of 3 cases","volume":"7","author":"Choudhary","year":"2017","journal-title":"J Clin Exp Hepatol"},{"key":"2025082713044650000_17.2.e257138.9","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s13224-018-1174-9","article-title":"Early onset Intrahepatic cholestasis of pregnancy: is progesterone supplementation to be blamed for","volume":"69","author":"Maiskar","year":"2019","journal-title":"J Obstet Gynaecol India"},{"key":"2025082713044650000_17.2.e257138.10","doi-asserted-by":"crossref","DOI":"10.12659\/AJCR.925690","article-title":"Delayed fulminant hepatic failure from Dydrogesterone-related in vitro fertilization therapy requiring liver transplantation during pregnancy","volume":"21","author":"Malherbe","year":"2020","journal-title":"Am J Case Rep"},{"key":"2025082713044650000_17.2.e257138.11","first-page":"49","article-title":"Dydrogesterone-induced hepatitis and autoimmune hemolytic anemia","volume":"15","author":"Altinta\u015f","year":"2004","journal-title":"Turk J Gastroenterol"},{"key":"2025082713044650000_17.2.e257138.12","first-page":"229","article-title":"Severe jaundice post embryo transfer: A case report","volume":"36","author":"Kamarul Bahyah","year":"2014","journal-title":"Giornale Italiano Di Ostetricia e Ginecologia"},{"key":"2025082713044650000_17.2.e257138.13","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1111\/1471-0528.17206","article-title":"Intrahepatic cholestasis of pregnancy","volume":"129","author":"Girling","year":"2022","journal-title":"BJOG"},{"key":"2025082713044650000_17.2.e257138.14","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jhep.2015.11.030","article-title":"Pregnancy and liver disease","volume":"64","author":"Westbrook","year":"2016","journal-title":"J Hepatol"},{"key":"2025082713044650000_17.2.e257138.15","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.430"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:04:53Z","timestamp":1756325093000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":15,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,21]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bcr-2023-257138"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257138","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}