Jaundice in Pregnancy

Subject: Midwifery I (Theory)

Overview

Jaundice occurs when the serum bilirubin level surpasses 2mg% and there is yellowish discoloration of the eyes, mucous membrane, and skin. Causes of jaundice during pregnancy include intrahepatic cholestasis, acute fatty liver, severe eclampsia, HELLP syndrome, severe untreated hyperemesis gravidarum, jaundice unrelated to pregnancy, viral hepatitis, chronic hepatitis, and liver cirrhosis. Jaundice symptoms include nausea, loss of appetite, general malaise, gastrointestinal trouble, and elevated serum bilirubin, blood urea, and liver enzymes. Viral hepatitis is an inflammation of the liver cells produced by a virus and is the most prevalent cause of jaundice during pregnancy. Premature labor, postpartum hemorrhage, hepatic failure, encephalopathy, and hepatic coma are all effects of jaundice on maternal health, and hemorrhagic manifestations increase maternal morbidity and death. Abortion, stillbirth, congenital deformity of the fetus and premature labor are all consequences of jaundice.

Jaundice occurs when the serum bilirubin level reaches 2mg percent (normal is 0.2 – 0.8 mg percent) and there is yellowish coloring of the conjunctiva, mucous membrane, and skin.

Causes of Jaundice During Pregnancy

Jaundice peculiar to the pregnant state

  • Cholestasis within the liver
  • HELLP syndrome, severe eclampsia, and eclampsia
  • Acute fatty liver disease
  • Hyperemesis gravidarum with severe neglect
  • DIC stands for endotoxic shock

Jaundice unrelated to pregnant state

  • Hepatitis virus
  • Jaundice due to hemolysis
  • Obstructive jaundice due to gallstones
  • Induced by drugs – isoniazid, phenothiazines

Jaundice when pregnancy is superimposed

  • Chronic hepatitis
  • Cirrhosis of liver

Viral Hepatitis

Viral hepatitis is an infection that causes inflammation of the liver cells and is the most prevalent cause of jaundice during pregnancy. It is found in both endemic and epidemic forms.

Causative organism of:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

Hepatitis A: The illness spreads via the fecal-oral pathway. The presence of IgM antibodies to hepatitis A confirms the diagnosis. Vertical transfer to a fetus is quite uncommon. Intragenic viruses do not exist.

Hepatitis B: The virus is spread by parental touch, sexual interaction, the placenta, and breast milk. The risk of transmission to a fetus is between 10% and 90%.

Hepatitis C: It is the most common cause of non-A and non-B hepatitis. Blood is the primary mode of transmission. Maternal problems are the most serious.

Hepatitis D: It is seen in chronic hepatitis B patients. Neonatal transmission is rare.

Hepatitis E: It is comparable to hepatitis A. The effects on the fetus are unknown at this time.

Clinical Features

  • Nausea, loss of appetite
  • General malaise
  • Gastrointestinal upset
  • Jaundice
  • Raised serum bilirubin, blood urea, and liver enzyme

Effects on Pregnancy

Maternal:

  • Premature labor
  • Postpartum hemorrhage
  • Hepatic failure
  • Encephalopathy
  • Hepatic coma and hemorrhagic manifestation lead to increased maternal morbidity and mortality.

Fetal:

  • Abortion, stillbirth
  • Intrauterine fetal death
  • Congenital malformation of the fetal
  • Premature labor
  • Possibility of a hepatitis-infected baby due to vertical transmission

Diagnosis

  • Physical examination
  • Ultrasonography
  • LIVER biopsy
  • Blood routine
  • Urine routine

Treatment

  • Rest: During the symptomatic stage, the patient should be kept in bed.
  • Hospitalization: In the worst-case scenario, she should be hospitalized to enhance her hepatic circulation.
  • Isolation: Isolation should be maintained for the patient. Blood samples must be taken with a gloved hand. The excreta must be disposed of with care.
  • Diet: Carbohydrate and protein-rich diet Initially, a glucose drink and fruit juice may be administered. If the patient is unable to accept oral feeding, 10% glucose may be administered intravenously.
  • Drugs: Oral neomycin 1gm 6 hourly is beneficial in preventing the production of a hazardous nitrogenous compound, while lactulose 15-30 ml TDS is beneficial in reducing calorie ammonia absorption and acting as an osmotic laxative.
  • During labor: Give 5mg of Vitamin K intravenously to help stop bleeding by increasing the prothrombin time.
  • Active management of the third stage of labor is required.

Prevention

  • Sanitation improvement.
  • Provide and consume safe drinking water.
  • Keep personal and food hygiene in check.
  • Hepatitis B prophylaxis requires the use of a sterilized and disposable syringe.
  • Blood donors should be frequently tested for HBsAg.
  • If a pregnant woman is exposed to an HBV-infected patient, she should receive 0.06 ml/kg IM HB immunoglobin (HBIG) soon after exposure and a second dose after 1 month.
  • At 0,1 and 6 months, health care personnel who work with jaundice patients should be immunized against HBV.
Things to remember
  • Jaundice occurs when the serum bilirubin level reaches 2mg percent (normal is 0.2 – 0.8 mg percent) and there is yellowish coloring of the conjunctiva, mucous membrane, and skin.
  • Jaundice during pregnancy can be caused by intrahepatic cholestasis, acute fatty liver, severe eclampsia, HELLP syndrome, severe untreated hyperemesis gravidarum, jaundice unrelated to pregnancy, viral hepatitis, chronic hepatitis, and liver cirrhosis.
  • Nausea, loss of appetite, general malaise, gastrointestinal trouble, elevated serum bilirubin, blood urea, and liver enzymes are clinical symptoms of jaundice.
  • Viral hepatitis is an infection that causes inflammation of the liver cells and is the most prevalent cause of jaundice during pregnancy. It is found in both endemic and epidemic forms.
  • Premature labor, postpartum hemorrhage, hepatic failure, encephalopathy, and hepatic coma are among the side effects of jaundice that increase maternal morbidity and death.
  • Abortion, stillbirth, congenital abnormality of the fetus, premature labor, and the potential of a hepatitis-infected baby due to vertical transmission are all consequences of jaundice.
  • Viral hepatitis has a unique therapy. It is generally encouraging. Isolation should be maintained for the patient. Blood samples must be taken with a gloved hand.
  • The excreta must be disposed of with care.
  • Oral neomycin 1gm 6 hourly is beneficial in preventing the production of a hazardous nitrogenous compound, while lactulose 15-30 ml TDS is beneficial in reducing calorie ammonia absorption and acting as an osmotic laxative.
  • At 0,1 and 6 months, health care personnel who work with jaundice patients should be immunized against HBV.
Questions and Answers

Jaundice is a yellow discoloration of the conjunctiva, mucous membranes, and skin that occurs when serum bilirubin levels are higher than 2 mg% (normal levels range from 0.2 to 0.8 mg%).

Jaundice is a yellow discoloration of the skin, mucous membranes, and conjunctiva that occurs when the blood bilirubin level reaches 2 mg% (the normal range is 0.2 to 0.8 mg%).

They are

Jaundice that is specific to pregnancy

  • Inside-the-liver cholestasis
  • HELLP syndrome, severe eclampsia, and eclampsia
  • Chronic fatty liver
  • Severe, untreated hyperemesis during pregnancy
  • DIC for endotoxic shock

Jaundice unrelated to pregnant state

  • Hepatitis virus
  • Hemolytic hepatitis
  • Obstructive jaundice due to gallstones
  • Drug-induced: phenothiazines and isoniazid

Jaundice when pregnancy is superimposed:

  • Chronic liver disease
  • Liver cirrhosis

Effects on Pregnancy

Maternal

  • Premature birth
  • Postpartum bleeding
  • Liver failure
  • Encephalopathy
  • Increased maternal morbidity and mortality are caused by hepatic coma and hemorrhagic manifestation.

Fetal

  • Birth defects and abortion
  • Fetal intrauterine death
  • Fetal congenital malformation
  • Premature birth
  • Possibility of vertical transmission resulting in a baby with hepatitis

Diagnosis

  • Examination of the body
  • Ultrasonography
  • BLOOD biopsy
  • Routine bloodwork
  • Normal urination

Treatment

Viral hepatitis has a specific treatment. In general, it is encouraging.

  • Rest
    • The patient should stay in bed while experiencing symptoms.
  • Hospitalization
    • In order to improve the hepatic circulation, she should be hospitalized if the condition is severe.
  • Isolation
    • It is best to keep the patient sedated. Gloved hands must be used to collect blood samples. It is important to properly dispose of the excreta.
  • Diet
    • A high-carb and high-protein diet. Fruit juice may be administered as a glucose drink at first. 10% glucose may be injected into the patient if they cannot tolerate oral feeding.
  • Drugs
    • Lactulose 15–30 ml TDS reduces calorie ammonia absorption and functions as an osmotic laxative, while oral neomycin 1 gm six hours a day is useful for preventing the formation of a toxic nitrogenous compound.
  • During labour
    • To increase the prothrombin time and help reduce bleeding, give a patient 5 mg of vitamin K intravenously.
  • Manage the third stage of the labor process actively.

Prevention

  • A rise in sanitary standards.
  • Water that is safe to drink and to use.
  • Food and personal hygiene should be maintained.
  • Using disposable, sterilized syringes to reduce the spread of hepatitis B.
  • Blood donors should routinely be tested for HbsAG.
  • If a woman is pregnant and comes into contact with a patient who has HBV infection, she should receive HB immunoglobin (HBIG) 0.06 ml/kg IM shortly after the exposure and a second dose one month later.
  • HBV vaccination should be given to medical staff handling jaundice patients at 0 months, 1 month, and 6 months.

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