Dr.P.VINEELA POST GRADUATE UNDER THE GUIDANCE OF Dr.

VIJAYASREE, PROFESSOR

INTRODUCTION: Jaundice may be co-incidental to pregnancy or due to a condition that is specific to pregnancy.

Pregnancy related causes includes intrahepatic cholestasis, pre-eclampsia, eclampsia , HELLP syndrome and acute fatty liver . Intercurrent causes includes acute viral hepatitis, biliary obstruction, hemolytic anemias, auto immune hepatitis, drug induced hepatitis and parenchymal liver disease.

 REVIEW OF SEVEN ANTENATAL MOTHERS WHO WERE ADMITTED WITH JAUNDICE COMPLICATING PREGNANCY AT MAMATA GENERAL HOSPITAL IN OBG DEPARTMENT..

CASE NO
1 2

ETIOLOGY
HELLP SYNDROME HELLP SYNDROME

3
4 5 6 7

PARENCHYMAL LIVER DISEASE

PARENCHYMAL LIVER DISEASE ACUTE VIRAL HEPATITIS INTRA HEPATIC CHOLESTASIS MALARIA COMPLICATING PREGNANCY

PATHO PHYSIOLOGY
Liver is an estrogen sensitive organ Estrogen affects organic anion transport (bilirubin, bile acids)

Bilirubin excretion very mildly impaired during

normal pregnancy
Biliary phospholipids secretion may be impaired (gene

mutation, estrogen effect)

Pregnancy is associated with decreases in GI motility,

including gall bladder motility

Physiological Consequences: The Liver in Pregnancy

Pregnant women more likely to become jaundiced if

cholestatic or hepatocellular injury occur

Spider angiomata and palmar erythema develop in up

to 2/3 pregnancies due to effects of estrogen and progesterone

Cholecystectomy generally safe

COMPLICATIONS :
. Jaundice in pregnancy leads to maternal morbidity like preterm deliveries ,meconium stained liquor,sepsis, renal failure . It is also one of the leading causes of maternal mortality in India. Fetal complications like fetal distress, respiratory distress syndrome, perinatal mortality, necrotising enterocolitis are also encountered.

NS ACUTE RENAL FAILURE RAISED BILIRUBIN, LIVER ENZYMES ,RFT

GIVEN 2 UNITS RDP, 1 UNIT FFP , 1 UNIT BT AND PACKED CELLS HAEMODIALY SIS DONE 1 UNIT FFP , HAEMODIALY SIS DONE

OUTCOME PATIENT EXPIRED

22 YRS OLD PRIMI WITH TG WITH HELLP SYNDROME

9 YRS OLD G2A1 WITH 35 WKS GA WITH HELLP SYNDROME

HEPATORENAL FAILURE , SEPTIC SHOCK

RAISED BILIRUBIN ,LIVER ENZYMES,RF T RAISED BILIRUBIN AND LIVER ENZYMES RAISED LIVER ENZYMES

RECOVERED

20 YRS OLD G3P1L1 WITH 33WKS GA WITH PARENCHYMAL LIVER DISEASE

2 UNIT BT

RECOVERED

8 YRS OLD PRIMI WITH TG WITH VIRAL HEPATITIS

3UNIT BT, 3UNIT FFP

RECOVERED

DIAGNOSIS

COMPLICATI LAB VALUES ONS

TREATMENT GIVEN

MATERNAL OUTCOME

24 YRS OLD G3P1L1A1 WITH TG WITH MALARIA 20 YRS OLD PRIMI WITH 32 WKS WITH PARENCHYMA L LIVER DISEASE 20 YRS OLD PRIMI WITH TG WITH INTRAHEPATI C

ACUTE RENAL FAILURE

PLASIMODIUM .FALCIPARUM +VE, RAISED BILURUBIN RAISED BILIRUBIN , RFT

2 UNIT BT ANTI MALARIAL TREATMENT, HAEMODIALY SIS DONE 3 UNIT FFP, 1 UNIT BT

RECOVERED

RECOVERED

RAISED BILIRUBIN, LIVER ENZYMES

MEDICAL MANAGEMEN T

RECOVERED

MODE OF DELIVERIES
PRE TERM 2

TERM 5
VAGINAL DELIVERIES 5 CESAREAN SECTIONS - 2

FETAL OUTCOME
LIVE BIRTHS 6
STILL BIRTHS 1

NEONATAL DEATHS - 2