Diseases of Pregnancy

1. INFECTIOUS DISEASES DURING
PREGNANCY
GROUP 2C

2. Malaria during pregnancy
Malaria during pregnancy tends to be very severe as it causes
problems to both the fetus and the mother.
To the mother it can cause : Chronic anemia to the point where it
can cause death, postpartum hemorrhage
To the infant it can cause: Miscarriage, preterm labour, low birth
weight, IUGR and IUFD

3. Cause
 This is due to the sequestration of the parasite in the placenta

4. Diagnosis
 Thick and thin blood films or the use of rapid diagnostic test.
 The presence of clinical signs and symptoms of malaria is also
diagnostic. Signs: Jaundice, fever, splenomegaly and
respiratory distress. Symptoms: fever, headache, muscle pain,
nausea, vomiting, diarrhea and cough.

5. Treatment
 The treatment depends on the trimester.
 In the first trimester, Quinine can be given orally or by IV
infusion.
 In the second and third, first line drug is Quartum which is
artemether and lumefantrine and the Quinine is usually as a
second line.

6. JAUNDICE

7. Bilirubin is a yellow pigment produced as a waste product in
the body. This is taken up by the liver and excreted in the bile.
Jaundice occurs when there is excess bilirubin in circulation.
The normal bilirubin levels range upto 0.1 to 1.2
mg/dl. Jaundice in pregnancy occurs when bilirubin levels are
greater than 2 mg/dl

8. Jaundice in pregnancy can occur due to:
Haemolysis of red blood cells due to various causes
which leads to an increased production in bilirubin.
Liver damage due to infections, drug toxicity, pregnancy
associated conditions like cholestasis, pre-eclampsia or
medical conditions like cirrhosis and cancers.
Obstruction to the flow of bile with gallbladder diseases like
blockage in the bile duct due to its narrowing or stones or

9. The most common cause of jaundice in pregnancy is Viral
Hepatitis.
Hepatitis A and E are caused by consuming contaminated food
and water.
The common modes of transmission of Hepatitis B, C and D
are blood and blood products, invasive medical procedures
using contaminated tools and sexual contact.
Hepatitis B can be transmitted from mother to baby at birth as
well.

10. What are other causes of jaundice in
pregnancy?
 Cholestasis of pregnancy:
 This condition is characterized by stasis of bile in liver and
overflow of bile salts into circulation. It predominantly presents
in the third trimester and the mother complains of itching all
over the body but without rash particularly in the palms and
soles. There is associated liver cell damage leading to increase
in liver enzymes. The liver transaminases (AST and ALT) levels
are usually two times the normal level in the blood and bilirubin
is usually mildly raised.

11.  Pre-eclampsia and HELLP syndrome:
This condition is associated with high blood pressure and excess
protein in the urine. In some mothers, this can cause liver
damage and elevated liver enzymes with jaundice.
H: RBC hemolysis
EL: Elevated liver enzymes
LP: low platelet count
 Hyperemesis gravidarum:
This occurs primarily in the first trimester and there is severe
uncontrolled vomiting. It may be associated with liver dysfunction
and mild jaundice.

12. Is Jaundice harmful during pregnancy?
 Jaundice in pregnancy in the majority of cases is mild and can
be managed successfully.
 However, in certain situations like pre-eclampsia or HELLP and
other medical illnesses, it can be associated with unfavorable
outcomes in the mother and baby depending upon the severity
of liver damage.

13. COMPLICATIONS
 severe liver damage leading
to liver failure and death
 neurological complications
 renal shutdown
 tendency to bleed
 preterm labour and
preterm delivery
 inadequate oxygenation
and growth of baby
 death of baby in womb and
stillbirth
 transmission of infections
like viral hepatitis B and E
from mother to baby
Maternal Fetal

14. How is jaundice in pregnancy diagnosed?
 A doctor will suspect jaundice in pregnancy if he/she notices
yellow discoloration of eyes and skin or if the patient complains
of passing dark urine.
 Nausea or vomiting, little appetite, fatigue and fever in case of
infections.
 Intense itching all over the body in the case of cholestasis.
 Pain in the upper abdomen and heartburn which doesn’t
subside with antacids in the case of gallstones.

15. Blood tests
 Liver function tests which include bilirubin and liver enzymes
(transaminases). They are very high in viral hepatitis,
moderately high in cholestasis and pre-eclampsia.
 Bile acid levels in suspected cases of cholestasis of
pregnancy.
 Ultrasound of the abdomen to evaluate the status of the liver,
presence of gallstones, severity of the damage in certain
medical disorders like cirrhosis and acute fatty liver of
pregnancy

16. How is jaundice in pregnancy treated?
 The aim of treatment is to manage the condition, prevent
medical complications and treat the underlying cause.
 In viral hepatitis, adequate nutrition and hydration with
supportive antibiotics to prevent add-on infections usually is
sufficient.
 In cholestasis of pregnancy, managing nausea, heartburn and
itching are important while in pre-eclampsia controlling blood
pressure with medications is essential.