Pharmacology of Obstetrics
Jaundice in pregnancy is a warning sign of liver dysfunction, hemolysis, or systemic disease. It is rare but serious — always investigate the cause.
Causes by Timing
Early (<20w)
- Viral hepatitis (A, B, E)
- Drug-induced
- Hemolytic anemia
Late (>20w)
- ICP: pruritus, ↑ bile acids
- AFLP: nausea, hypoglycemia
- HELLP: hemolysis, ↑ LFTs, ↓ platelets
Maternal Risks
- Liver failure, coagulopathy
- Hemorrhage
- Death (AFLP, severe hepatitis)
Fetal Risks
- Preterm birth
- IUGR
- Fetal distress, stillbirth
Diagnosis
- History: onset, symptoms
- Labs: LFTs, coagulation, viral serology
- Ultrasound: biliary obstruction
Differentiate ICP, HELLP, AFLP
Management
- ICP: UDCA, induce at 37–38w
- HELLP: Stabilize, deliver
- AFLP: ICU, urgent delivery
- Hepatitis: Supportive, monitor
Summary Table
| Condition | Timing | Features | Maternal Risk | Fetal Risk | Management |
|---|---|---|---|---|---|
| ICP | 3rd | Pruritus, ↑ bile acids | Mild | Preterm, stillbirth | UDCA, delivery 37–38w |
| HELLP | 3rd | Hemolysis, ↑ LFTs, ↓ platelets | Liver hematoma, DIC | Prematurity | Urgent delivery |
| AFLP | 3rd | Nausea, hypoglycemia | Liver failure | High mortality | ICU, delivery |
| Viral Hepatitis | Any | Malaise, ↑ AST/ALT | Liver failure | Stillbirth | Supportive |
Key Takeaways
- Rare but serious
- Early: hepatitis/drugs
- Late: ICP, HELLP, AFLP
- Maternal danger: encephalopathy
- Fetal: preterm, distress
Conclusion
Jaundice demands prompt evaluation. Etiology guides management — from supportive to urgent delivery.
Jaundice in pregnancy is a red flag — act fast.