Jaundice in Pregnanc

1. Jaundice in pregnancy
Incidence in India – 1 in 1000
Three types
Pregnancy induced liver diseases
Antecedental to pregnancy
Coincidental liver diseases
1
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2. Viral hepatitis
Drug induced jaundice
Antecidental to pregnancy
Congenital hyperbilirubinaemia
Cirrhosis
Chronic hepatitis
Pregnancy induced liver diseases
Hyperemesis graviderum
Cholestasis of pregnancy 2
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3. Resolve spontaneously
Cholestasis of pregnancy
Aetiology not known. Due to oestrogen
Genetic basis.
Increased bile acids.
OC pills
Clinical features
Itching – in 3rd trimester
Rarely jaundice
Investigations 3
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4. Induction of labor at 38 wks
Intrapartum fetal surveillance
Inj. Vit. K reduces PPH and fetal i/c
bleed
For pruritus- Ursodeoxycholic acid
300mg bd
Maternal and perinatal outcome
Serious complications rare.
Unexplained IUD, rarely fetal
coagulopathy
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5. Acute Fatty Liver of Pregnancy
Occure in 3rd trimester.
High maternal and fetal mortality
Aetiology
1st pregnancy, pre eclampsia,multple
pregnancy, obesity.
Clinical features
Non- specific. Nausia, vomiting, 5
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6. 6
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7. Moderate increase in serum bilirubin,
SGOT,
SGPT & alkaline phosphatase.
Increased PT, Coagulation failure
,, uric acid &
hypoglycemia
Managament
Termination of pregnancy
Correct coagulation failure, renal failure
and
Hypoglycemia.
Prognosis 7
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8. Hepatitis A
Feccal- oral route
Diagnosis by HAV IgM
Prophylactic Ig.
Hepatitis B
Long incubation period of 6 wks – 6
months
By blood, blood products,body fluids,
Injection by contaminated needles
Mother HbsAg positive – more fetal affection
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9. LFT abnormal.
Serology to identifyorganism.
Recovery within 2-3 wks.
Management
Hospitalisation
Supportive measures – rest,high CHO
and
Low fat diet,i/v dextrose, inj.Vit K
Antibiotics oraly
Avoid hepatotoxic drugs 9
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10. Immunisation of all health care personnel
Disposable syringes and needles.
Hepatitis Ig to babies of HbsAg positive mothers
Hepatitis B recombinant vaccine to the baby.
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11. Thank You
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