Maternal and Perinatal Outcome in Jaundice Complicating Pregnancy [PDF]

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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



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 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



GIVEN



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 CELLS HAEMODIALY SIS DONE



PATIENT EXPIRED



9 YRS OLD G2A1 WITH 35 WKS GA WITH HELLP SYNDROME



HEPATORENAL FAILURE , SEPTIC SHOCK



RAISED BILIRUBIN ,LIVER ENZYMES,RF T



1 UNIT FFP , HAEMODIALY SIS DONE



RECOVERED



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



RAISED BILIRUBIN AND LIVER ENZYMES



2 UNIT BT



RECOVERED



8 YRS OLD PRIMI WITH TG WITH VIRAL HEPATITIS



RAISED LIVER ENZYMES



3UNIT BT, 3UNIT FFP



RECOVERED



DIAGNOSIS



COMPLICATI LAB VALUES ONS



TREATMENT GIVEN



MATERNAL OUTCOME



24 YRS OLD G3P1L1A1 WITH TG WITH MALARIA



ACUTE RENAL FAILURE



PLASIMODIUM .FALCIPARUM +VE, RAISED BILURUBIN



2 UNIT BT ANTI MALARIAL TREATMENT, HAEMODIALY SIS DONE



RECOVERED



20 YRS OLD PRIMI WITH 32 WKS WITH PARENCHYMA L LIVER DISEASE



RAISED BILIRUBIN , RFT



3 UNIT FFP, 1 UNIT BT



RECOVERED



20 YRS OLD PRIMI WITH TG WITH INTRAHEPATI C



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