Book of Medical Disorders in Pregnancy - Tintash

transaminases are normal or may be
slightly raised. The jaundice is usually
mild and may mani-fest itself in the later
weeks of pregn-ancy. The main
symptom is pruritus. The stools are pale
and the urine is dark. Usually there is no
hepatosplenomegaly.
Treatment - The pruritus is due to
accumulation of bile salts and not the
bilirubin. This disappears shortly after
delivery. The jaundice also settles in few
weeks. The drug cholestyramine may
help to alleviate distressing cases of
pruritus. It is an anion exchange resin
that binds the bile acids in the intestine
and interferes with their absorption. The
safety of this drug in pregnancy has not
been fully evaluated therefore it should
be used with great caution and after organogenesis
has been completed which
occurs at 12 weeks of gestation. The disease
often recurs in subsequent pregnancies
and there may even be a family
history. The fetal as well as maternal
prognosis is good but there have been
sporadic reports of repeated' still-births
in recurrent cases. Since a similar picture
may de-velop in patients who are on oral
con-traceptives such patients should not
be further prescribed these drugs.
Obstetric management: Simple
reassurance, with treatment of pruritus is
all that is required. Both pregnancy and
labour often proceed normally. The
diagnosis must be established correctly
before adopting such expectant attitude.
Fig8.4: Shows histopathology of fatty
liver
112
Acute fatty liver of pregnancy - This
condition is also described in the literature
as obstetric acute yellow atrophy.
Most cases are associated with severe
malnutrition or occur in patients who
have been given large doses of tetracyclines.
Liver cells during pregnancy are
especially sensitive to cytotoxic effect of
these drugs. This condition is not very
common. It usually occurs in the last
trimester. The hepatic cells become grossly
infiltrated with fat. Both transaminases
and alkaline phosphatase are
slightly increased. The prognosis for
both mother and the fetus is very poor.
There is no specific treatment. Lipotrophic
factors, corticosteroids, B complex
vitamins and early delivery have all been
tried without much success. These measures
on the other hand may be harmful.
Preeclampsia and eclampsia - Jaundice
in such patients is due to hemo-lysis. It
is a rare condition but who it oc-curs; it
is usually fatal.
Hyperemesis gravidarum - In very
severe cases of hyperemesis gravidarum,
malnutrition leads to fatty infiltration of
the liver, and then subsequently to jaundice.
Dehydration produced by excessive
fluid loss may also cause jaundice.
Jaundice coincidental to pregnancy -
Usual medical and surgical causes of
jaundice may be present during pregnancy
and should be kept in mind for
differential diagnosis.
Pre hepatic causes - Hemolysis due to
defects in RBC shape and size, hemoglobinopathies,
parasites like malarial, incomepatible
blood transfusion, drugs
and pyogenic infections can cause jaundice.