maternal and neonatal

4. Definition
When serum bilirubin level exceeds 2mg%
(normal being 0.2-0.8mg%), with yellowish
discoloration of conjunctiva, mucous membrane and
skin called jaundice. It results from increased
concentration of bilirubin in the body fluids.

7. Causes
The cause of jaundice during pregnancy
may be grouped as follows;
1. Jaundice peculiar to the pregnant state
*Intrahepatic cholestasis (10%)
*Severe pre-eclampsia, eclampsia
*Acute fatty liver
*Severe neglected hyperemesis gravidarium

8. 2. Jaundice unrelated to pregnant state
*Viral hepatitis (80%)
*Hemolytic jaundice
*Gallstone
*drug induced
3. Jaundice when pregnancy is superimposed
*Chronic hepatitis
* Cirrhosis of liver

10. Viral hepatitis
Viral hepatitis is an inflammation of the liver
cells caused by a virus and most common cause of
jaundice in pregnancy. It occurs in endemic and
epidemic forms.
The viruses are mainly of 5 types;

13. Hepatitis A (HAV)
o Infection is spread by fecal- oral route. Diagnosis is
confirmed by detection of IgM antibody to hepatitis
A.
o Vertical transmission to fetus is rare.
o Pregnant woman exposed to HAV infection should
receive immunoglobulin 0.02ml/kg within 2 weeks of
exposure.

14. • She should also have hepatitis A vaccine single dose
0.06ml IM.

15. Hepatitis B (HBV)
The virus is transmitted by parenteral route, sexual
contact, vertical transmission and rarely through
breast milk.
The risk of transmission to fetus ranges from 10% in
first trimester to as high as 90% in 3rd trimester and it
is specially high (90%) from those mothers who are
seropositive to HBsAg.

17. Neonatal transmission mainly occurs at or around the
time of delivery through mixing of maternal blood
and genital secretions.

18. Hepatitis C (HCV)
• It is recognized as the major cause of non-A, non- b
hepatitis.
• Transmission is mainly blood borne and to a lesser
extent by fecal-oral route.
• Perinatal transmission (10-40%) is high when viral
load is high.

19. • No effective vaccine against HCV is available women
should be immunized against hepatitis A and B if not
immune.

20. Hepatitis D(HDV)
It is seen in patients infected with HBV
either as a co-infection or super infection. Neonatal
transmission is uncommon.

21. Hepatitis E(HEV)
It behaves similar to hepatitis A virus
infection. Perinatal transmission is uncommon.
Maternal mortality following acute infection is high
(15-20%)

23. Clinical features
o Nausea, loss of appetite
o General malaise
o Raised serum bilirubin, blood urea, liver enzyme
o Dark urine and clay coloured stool

25. Effect / complication
1. Maternal
*Premature labour
*Postpartum hemorrhage
*Hepatic failure
*Encephalopathy
*Hepatic coma and hemorrhagic manifestation

26. 2. Fetal
*Abortion, still birth
*Intrauterine fetal death
*Congenital malformation of the fetus
*Premature labour
*Possibility of hepatitis infected baby due to
vertical transmission.

27. Prevention
 Improvement in sanitation, supply of safe drinking
water and adequate care of personal hygiene are the
essential prerequisites.
 Supply and use safe drinking water.
 Maintain personal and food hygiene.

29.  Use of sterilized and disposable syringe for
prevention of hepatitis B.
 Screening of blood donors for HbsAg should be
routinely done.
 If pregnant woman is exposed to a patient with HBV
infection, she should have HB immunoglobin (HBIG)
0.06ml/kg intramuscularly soon following exposure
and 2nd dose after 1 month.

31.  Health care personal handling the jaundice patient
should be protected with HBV vaccine at 0, 1 and 6
months. During Delivery double gloves techniques
should be provided.

32. Treatment
1. Rest
2. Hospitalization
3. Isolation
4. Diet
5. Drugs
6. During labour

33. 7. Severe pruritus may be treated with cholestyramine.
8. Increased perinatal and maternal mortality. Operative
delivery is associated with significant risk of post
operative hepatic faliure.
9. Perform active management of 3rd stage of labour to
prevent postpartum hemorrhage.

34. Prevent transmission to child
• In newborn the risk of vertical transmission is 25%
when the mother is HBsAg negative but 80-100% if it
is positive.
• When the mother is infected with hepatitis B, the new
born is given Hepatitis B immuno-globulin within 12
hours of birth and hepatitis B vaccine within 7 days
of birth. This provides 90-95% protection to neonate.

35. • Pregnant woman who have been exposed to Hepatitis
A should be given gammaglobulin prophylaxis as
early as possible.
• Women when exposed to cause of Hepatitis B, should
receive Hepatitis B vaccine in full dose.