Book of Medical Disorders in Pregnancy - Tintash

(2) In hepatitis 'B' Australia Antigen positive
cases, special precautions are taken
to avoid spread to the baby as well
as to the attendants. (3) The babies thus
born are given hepatitis 'B' I immunoglobulin
and possibly hepatitis B vaccine.
(4) These babies need to be taken
off the breast feed.
Fig8.5: Shows source of infection
which is usually infected needle
Obstetric management - In most cases
this is not influenced by the presence of
jaundice. However, if investigations
show deficiency of blood clotting factor,
then fresh blood or prothrombin complex
should be available to avoid postpartum
hemorrhage.
Drug in the jaundiced Patient -' Most
drugs are detoxicated by the liver. The
drugs have also toxic effect on the liver
especially when it is damaged. Their
action may be prolonged so a careful
individual assessment and adjustment
will be required.
Mortality: Contrary to that in European
countries, fatality from viral hepatitis in
pregnancy is high in underdeveloped countries,
particularly in third trimester.
No single liver function test is available
to quantify liver disease. The designation
"liver function tests" describes a panel of
laboratory tests profiling discrete aspects
of liver function. 1 Liver cell injury or
114
necrosis is measured by determining
aspartate aminotrans-ferase (AST) and
alanine aminotransferase (ALT) levels,
while liver synthetic function (depressed
in cirrhosis or severe acute liver disease)
is quantified by determining albumin
level and prothrombin time. Cholestasis
and biliary obstruct-tion are evaluated by
measuring alkaline phosphatase,
bilirubin, and nucleotides or gamma
glutamyl trans-pepti-dase levels 1 (Figure
1). In normal pregnancies, alkaline
phosphatase levels may be elevated
three- to fourfold, secondary to placental
alkaline phos-phatase levels. Elevations
of ALT occurring during pregnancy can
be evaluated using a diagnostic
algorithm (Figure 2). Ele-vated ALT is
frequently the result of viral hepatitis,
which can be easily dia-gnosed using
serologic tests. Other possible etiologies
of mild or moderate elevations of ALT
are drug induced hepatotoxicity,
hyperemesis gravidarum, cholelithiasis,
HELLP (hemolysis, ele-vated liver
enzymes and low platelet count)
syndrome or acute fatty liver of
pregnancy.
Pregnancy and hepatitis acute viral
hepatitis: Viral hepatitis is the most
common cause of jaundice in
pregnancy.4 The course of most viral
hepatitis infections (e.g., hepatitis A, B,
C and D) is unaltered by pregnancy.6,7
However, a more severe course of viral
hepatitis in pregnancy has been noted in
patients with hepatitis E and
disseminated herpes simplex virus
(HSV) infections.2,6,8-11 Hepatitis E is
a waterborne virus spread through fecaloral
transmission. Infection occurs most
commonly in developing countries after
flooding. Pregnant women with hepatitis
E infection exhibit markedly increased
fatality rates (10 to 20 percent).