Jaundice in pregnancy can be caused by hemolytic, hepatocellular, or obstructive factors. Hemolytic jaundice may be due to blood transfusion incompatibility or infection, hepatocellular jaundice can result from viral hepatitis, preeclampsia, acute fatty liver of pregnancy, or drugs/alcohol, and obstructive jaundice may be from cholestasis of pregnancy, gallstones, or other conditions. Cholestasis of pregnancy is caused by estrogen sensitivity and shows a familial tendency, with symptoms of itching and mild jaundice. It can lead to complications like postpartum hemorrhage, premature labor, and stillbirth, so induction of labor is

1. Jaundice in
Pregnancy
Dr.MSc. Raul Hernandez Canete

2.  Incidence: This occurs in about 1 in 1,000
pregnancies and is most common due to viral
hepatitis.
 Etiology: Classification is traditionally into the
following categories: Hemolytic,
Hepatocellular, and Obstruction.
 Causes may be consequential to, or
independent of, the pregnancy

3. Jaundice in pregnancy:
 Hemolytic:
- Incompatible blood transfusion
- Cl. Perfringens, E. coli/septicemia
 Hepatocellular:
- Viral hepatitis
- Severe preeclampsia
- Acute fatty liver of pregnancy
- Alcohol and drugs (e.g. halothane)
- Autoimmune chronic active hepatitis

4. Cont. of jaundice in pregnancy
 Obstructive:
- Cholestasis of pregnancy
- Cholelithiasis
- Drugs (e.g. Chlorpromazine)
- Primary biliary cirrhosis
- Pancreatic carcinoma

5. Diagnosis:
 Careful history and examination
 Biochemical test
 Ultrasound
Biochemical test will help to differentiate between
hepatocellular damage and obstruction:
- Hepatocellular: predominantly unconjugated bilirubin
and hepatocellular enzymes (aspartate
transaminase or alanine transaminase)
- Cholestasis (intrahepatic or extrahepatic):
predominantly conjugated bilirubin and alkaline
phosphatase

6. Cholestasis of pregnancy:
 Pathogenesis: is due to an estrogen sensitivity
effect and exhibits a familial tendency. It is
frequently recurrent in successive pregnancies or if
the women is prescribed oral contraceptives.
 Clinical features: mild jaundice, malaise, and itching
of the skin.
Liver function tests (alkaline phosphatase, urine
urobilinogen) suggest biliary obstruction, cholic acid
levels are typically elevated .
Serum bilirubin is rarely more than 85 mmol/L

7.  Effect of Cholestasis on pregnancy:
 Postpartum hemorrhage (reduced vitamin K
absorption)
 Premature labour (30%)
 Stillbirth.
 Management: Other causes of jaundice should be
excluded, USG and CTG (fetal well-being),
cholestyramine resin is effective for pruritus,
Induction of labour is indicated at 37-38 weeks or
earlier if there is fetal compromise.
The condition resolves rapidly after pregnancy.

8. Acute fatty liver of pregnancy:
 Is unique to pregnancy
 More common in primigravidas
 Extremely uncommon before the late second
trimester
 It may follow intravenous tetracycline
administration or prolonged vomiting

9. Clinical features of AFL
 The syndrome comprises malaise, fatigue,
epigastric discomfort and vomiting. Jaundice soon
follows. There may be hypertension and proteinuria.
Risk of PPH. Hepatic encephalopathy may be
develop
 Laboratory studies reveal a significant leucocytosis,
moderately disturbed liver function, hypoglycemia
impaired renal function and often coagulopathy
 The mortality may be 50% or more without energetic
treatment.

10. Management of AFL:
 Intensive Unit Care
 Adequate intravenous fluids
 Albumin, glucose and vitamin K
 Correction of coagulation defects
 The pregnancy should be terminated, usually
by CS.

11. Severe Preeclampsia
(including HELLP syndrome)
 May be part of the spectrum of Acute fatty liver
 Has a predisposition for late pregnancy and
primigravidas
 Widespread endothelial cell damage resulting in
hemolysis and thrombocytopenia
 The women needs to be stabilized and delivered
regardless of gestational age
 There are some reports of a beneficial effect of
coticosteroids.