Jaundice In Pregnancy

Question 1

What are the causes of jaundice in pregnancy?

Answer 1

Obstetric cholestasis
Acute fatty liver disease of pregnancy
Viral hepatitis
Jaundice of severe pre-eclampsia
HELLP syndrome

Question 2

What are the tests that need to be done to investigate jaundice?

Answer 2

Urine tests for bile 
Serology 
LFTs
USS
Bile acids

Question 3

How does obstetric cholestasis present?

Answer 3

Pruritis especially of the palms and the soles
No rash and worse at night
Typically in the second half of pregnancy

Question 4

How is obstetric cholestasis diagnosed?

Answer 4

Diagnosis of exclusion - check for viral hepatitis, autoimmune screen and USS liver
Liver transaminases, bilirubin and bile acids elevated

Question 5

What are the risks with obstetric cholestasis?

Answer 5

Foetal distress
Preterm labour
Meconium
Stillbirth

Question 6

What is the management for obstetric cholestasis?

Answer 6

IOL at 37-38 weeks
Vitamin K to the mother if abnormal clotting and IM to the baby at birth
Ursodeoxycholic acid to reduce pruritis and abnormal LFTs
Symptoms resolve within days of delivery

Question 7

Can obstetric cholestasis recur after delivery?

Answer 7

Yes.

On oestrogen-containing contraceptives or in subsequent pregnancies.

Question 8

What is the presentation of acute fatty liver disease of pregnancy?

Answer 8

Abdominal pain
Jaundice
Headache
Vomiting
Thrombocytopenia
Pancreatitis
Associated preeclampsia in 30-60%
Usually occurs after 30 weeks

Question 9

What is the management of acute fatty liver disease of pregnancy?

Answer 9

Manage in HDU or ITU
Monitor BP
Give supportive treatment for liver and renal failure
Treat hypoglycaemia vigorously with a CVP line
Correct clotting disorders
Expedite delivery
Epidural and regional anaesthesia - contraindicated
Beware PPH and neonatal hypoglycaemia