Jaundice in Pregnancy-Most Common Cause -Viral Hepatitis-Complications -Management

1. Viral hepatitis is most common in poor ,unhygienic , malnourished pregnant ladies
2. 6 major types: Hepatitis -A,B,C,D,E,G
3. All are RNA viruses except Hepatitis -B which is DNA virus
4. Complications for mother : Increase severe bleeding immediately after delivery  (PostPartumHaemorrhage ),Coma ,Blood Coagulopathy, Infection , Hepatorenal syndrome,Maternal death
5. Complications to fetus: Abortions, Abnormal babies, Delivery of fetus with out completing full term , Fetal death in utero.

Management:

1. Hospitalisation
2. Bed rest
3. Isolation of the infected patient
4. High Calories ,Rich Carbohydrates food
5. Proteins to be given adequate quantity
6. Proper Hygiene ,Safe water ,Safe food is must
7. .Disposable syringe/Gloves are advised for paramedical staff to prevent contamination , infection from patient to others
8. Glucose , fruit juice ,tender coconut water, etc Liquids  to be given plenty
9. Antibiotics,those donot give overload on liver
10. Fatty food may harm jaundice  patient but not proved much
11. Drugs which cause liver toxicity should be avoided
12. lactulose-Osmatic laxative  can be given daily to clear bowel fecal contest
13. Mother  to be taken Active Immunization at 0 day , 1month ,6 months -If mother is not infective clear cut way
14. Immunoglobulins are safe in pregnancy.Hepatitis vaccines are also safe during pregnancy
15. Regular Blood tests
16. Blood /fresh frozen plasma
17. Vit-K 5mg IM -Increase PT-Helpful
18. No Role of Termination of pregnancy_canot change final result or mortality of mother.
19. Inj Ergometrine Immediately after delivey of baby to prevent post partum haemorrhage.
20. Baby of jaundice infected mother should be recived  active and passive immunisation immediately after birth.
21. No contra indication to breast feeding feeding
22. All women should be recieved Hepatitis vaccine six months prior to pregnancy.
23. Husband also has to be tested and treated or vaccinated for hepatitis

3.

Jaundice Hepatits Complicating Pregnancy ..what it is?.What are the causes ?

When pregnant is declared as jaundice patient?

1.Her serum bilirubin level should be more than normal
2.Visible yellow staining of conjunctiva,skin of other bodyparts

Why jaundice occur in pregnant women?

Causes of jaundice in pregnant lady can be grossly divided into two groups
1.Exclusively pregnancy related causes:
 A) Hyperemesis ( Exessive vomiting during first 3 months period of pregnancy)
 B) Hypertensive disorders of pregnancy like Preeclampsia ( High BP+ Albuminuria +_ Pedal edema) , Eclampsia ( Pre eclamsia + fits) , DIC ( Uncontrollable bleeding disease -High deathRates -Endotoxic shock)
 C) Liver diseases like Acute fatty liver
 D) Most Common - Intra partum choleastasis ( Pregnancy specific hepatic ,gall bladder ,Bile duct abnormality ,function, obstruction )

Second group of causes of jaundice in pregnancy which are unrelated to pregnancy are as follows
A) Most common causes : Viral hepatitis
B) Gallstone-Obstructive jaundice
C) Drugs -Isoniazide, Phenothiazine etc
D) Hemolyticjaundice-Mismatched blood transfusion ,
                                  Malaria , Infection.

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