Jaundice

Question 1

What are causes of jaundice in pregnancy?

Answer 1

Obstetric cholestasis
Acute fatty liver of pregnancy
Viral hepatitis
Jaundice of severe pre-eclampsia
HELLP syndromeWhat tests for jaundice?

Question 2

What tests for jaundice

Answer 2

FBC
LFT
U&E
Serology
Coomb's test
Haptoglobin
Urine test for bilirubin
US

Question 3

What is obstetric cholestasis? What are features of intrahepatic cholestasis of pregnancy?

Answer 3

Impaired flow of bile - build up of bile salts - deposit in skin as well as placenta

Pruritus, often in palms and soles
No rash
Worse at night

Raised bilirubin
Transaminases mildly raised

Diagnosis of exclusion
- test for viral heaptitis, autoimmune screen and US of liver

Question 4

What are risks of obstetric cholestasis?

Answer 4

Preterm labour
Fetal distress - immature fetal liver ability to cope with breaking down excess bile salts as well as vasoconstriction effect of bile salts on human placental chorionic veins – suddenly asphyxial events
Meconium
Stillbirth

Question 5

What is management of obstetric cholestasis

Answer 5

Ursodeoxycholic acid reduces pruritus and abnormal LFTs
Vitamin K to mother if abnormal clotting screen and IM to baby at birth
Weekly LFT
Induce at 37 weeks

Question 6

What are features of acute fatty liver of pregnancy?

Answer 6

Abdominal pain
N/V
Headache
Jaundice
Hypoglycaemia
± Thrombocytopenia and pancreatitis

Associated with pre-eclampsia

Occurs after 30 weeks

Question 7

What investigations in acute fatty liver of pregnancy?

Answer 7

ALT elevated > 500

Question 8

What is management for acute fatty liver of pregnancy?

Answer 8

Supportive
Treat hypoglycaemia
Correct clotting

Delivery is definitive
Epidural and regional anaesthesia are CI

Question 9

What is management for viral hepatitis in pregnancy?

Answer 9

Elective C-section in those with coexistent HIV not on HAART

Check baby fro HCV RNA at 2-3 months

Question 10

What is HELLP syndrome?

Answer 10

Haemolysis
Elevated liver enzymes
Low platelet count