MATERNAL AND PERINATAL OUTCOME IN JAUNDICE

COMPLICATING PREGNANCYDr.P.VINEELAPOST GRADUATEUNDER THE GUIDANCE OFDr. 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

ETIOLOGY

1 HELLP SYNDROME

2 HELLP SYNDROME

3 PARENCHYMAL LIVER DISEASE

4 PARENCHYMAL LIVER DISEASE

5 ACUTE VIRAL HEPATITIS

6 INTRA HEPATIC CHOLESTASIS

7 MALARIA COMPLICATING PREGNANCY

PATHO PHYSIOLOGYLiver 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 PregnancyPregnant 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

. 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.

COMPLICATIONS :

DIAGNOSIS COMPLICATIONS

LAB VALUES

TREATMENT GIVEN

MATERNAL OUTCOME

22 YRS OLD PRIMI WITH TG WITH HELLP SYNDROME

ACUTE RENAL FAILURE

RAISED BILIRUBIN, LIVER ENZYMES ,RFT

2 UNITS RDP, 1 UNIT FFP , 1 UNIT BT AND PACKED CELLSHAEMODIALYSIS DONE

PATIENT EXPIRED

19 YRS OLD G2A1 WITH 35 WKS GA WITH HELLP SYNDROME

HEPATORENAL FAILURE , SEPTIC SHOCK

RAISED BILIRUBIN ,LIVER ENZYMES,RFT

1 UNIT FFP , HAEMODIALYSIS DONE

RECOVERED

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

RAISED BILIRUBIN AND LIVER ENZYMES

2 UNIT BT RECOVERED

18 YRS OLD PRIMI WITH TG WITH VIRAL HEPATITIS

RAISED LIVER ENZYMES ,BILIRUBIN AND RFT

3UNIT BT, 3UNIT FFP

RECOVERED

DIAGNOSIS COMPLICATIONS

LAB VALUES TREATMENT GIVEN

MATERNAL OUTCOME

24 YRS OLD G3P1L1A1 WITH TG WITH MALARIA

ACUTE RENAL FAILURE

PLASIMODIUM.FALCIPARUM +VE, RAISED BILURUBIN

2 UNIT BTANTI MALARIAL TREATMENT, HAEMODIALYSIS DONE

RECOVERED

20 YRS OLD PRIMI WITH 32 WKS WITH PARENCHYMAL LIVER DISEASE

RAISED BILIRUBIN , RFT

3 UNIT FFP,1 UNIT BT

RECOVERED

20 YRS OLD PRIMI WITH TG WITH INTRAHEPATIC CHOLESTASIS

RAISED BILIRUBIN, LIVER ENZYMES

MEDICAL MANAGEMENT

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