Jaundice in Pregnancy

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Hemolysis

SCD: history of recurrent jaundice, repeated blood transfusion, genotype, sickle cell habitus, maybe otherwise healthy.

Malaria: other signs and symptoms of malaria- fever, chills and rigor, joint pains, etc.

G6PD deficiency: use of sulphanamides, camphor, primaquine, local herbs.

Sepsis: other signs of acute infection.

Blood transfusion reaction: recent blood transfusion.

Anemia is a major finding.

Viral hepatitis

Hepatitis A: causes self-limiting hepatitis without chronic sequelae.

Non A-non B hepatitis: post transfusion or serum hepatitis; caused by hepatitis C virus.

Hepatitis B: commonest, of obstetric concern, commoner in Asia and Africa.

Risk factors— sharing of needles, low social status, health workers.

HBV Infection

Fever, jaundice, intractable vomiting, HBsAg+

Danger signs: drowsiness, sudden change in mood, twitching, flapping tremors, muscular rigidity.

These changes herald hepatic failure.

May also manifest with psychosis.

Neurological manifestation- convulsion

Coma

DNA virus, incubation period 6/52 to 6/12.

2/3rd infection are asymptomatic.

Blood, blood products, coitus, IV drug abuse

RUQ pain, anorexia, vomiting (50%).

In adults: 90% resolve within 6/12, 10% become chronic carriers.

Vertical transmission: 95% delivery, 5% transplacental.

Fetal issues: no congenital abnormality, high risk of chronic hepatitis and liver cirrhosis later in life.

Obstetric cholestasis

Severe pruritus especially palms and soles.

Onset usually in third trimester.

Associated anorexia, steatorrhea, and dark (coca cola colored) urine.

Jaundice is rare.

Moderate elevation of transaminases, ALP.

Associated with preterm labor, fetal distress, meconium stained liquor, IUFD, PPH.

Gallstones

Associated with RUQ/epigastric pain radiating to the back or interscapular area.

Nausea and vomiting

Can occur in any trimester.

Tenderness and guarding in right hypochondrium.

Fever may occur due to superimposed sepsis.

Pre-eclampsia/HELLP syndrome

Occur in second half of pregnancy

HTN, proteinuria, thrombocytopenia, epigastric or right hypochondrial pain.

Jaundice.

Acute fatty liver of pregnancy

Nausea, vomiting, malaise, abdominal pain.

Coexisting features of mild PET.

Hyperuricemia is marked.

Coagulopathy is prominent

Jaundice with ascites

Severe LFT derangement.

Fulminant course with liver failure, renal failure and encephalopathy.

Mortality approximately 100%.

Sepsis

Acute cholecystitis

Ascending cholangitis

Fever, abdominal pain

Other signs of sepsis

Drug-induced hepatotoxicity

Aldomet

Halothane

Chlorpromazine

History: GA, previous occurrence, blood transfusion, fever, surgery (inhalational anesthesia?), drug history, genotype.

Examination: general, temperature, focus of infection, BP, hepatomegaly, fetal well-being.

Investigations: PCV, urinalysis, LFT, E/U/Cr, HbSAg, USS (obstetric, pelvic), MP, blood film, genotype, clotting profile, blood culture, urine m/c/s

Treatment

Supportive care

Tailored towards each causative agent

Admit: bed rest, high calorie intake

Vitamin B complex

Avoid hepatotoxic drugs e.g. sulphanamide.

Broad spectrum antibiotics.

If in labor, give vitamin K after delivery and prophylaxis for PPH.

HBV infection

Immune globulin to newborn within 12 hours of delivery to reduce the risk of vertical transmission.

Test infant at 10 to 15 months.

First dose of HB vaccine within 7 days of delivery, second dose at 1 month, third dose at 6 months.

Maternal HBV infection is not a contraindication to breastfeeding.

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Jaundice in pregnancy

What You Will Learn

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