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Answer 4
  1. Induction of labor. The patient has HEELP syndrome as demonstrated by her presentation and laboratory findings. The exact cause of HEELP syndrome is unknown. If untreated, HEELP syndrome can progress to fulminant hepatic failure, leading to maternal and/or fetal death. Fetal delivery is the cornerstone of therapy, especially in a pregnancy that is almost full-term. Platelet transfusion would not be helpful nor would administration of ursodeoxycholic acid. Observation is unwise in this case given the advanced state of pregnancy and the hepatic abnormalities. Liver biopsy should be avoided given the risk of hematoma and hepatic rupture in thrombocytopenic patients with HEELP syndrome.

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