GuidelinesOther guideline
Jaundice
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Causes of jaundice in pregnant women
CAUSES OF JAUNDICE IN PREGNANT WOMEN
Pregnancy related
- Severe pre-eclampsia or HELLP syndrome
- Acute fatty liver of pregnancy
- Severe hyperemesis gravidarum
- Intrahepatic cholestasis of pregnancy
- Severe sepsis
Not related to pregnancy
- Acute viral hepatitis
- Drug induced jaundice
- Haemolysis including malaria
- Other causes e.g. chronic liver disease or enzyme defects
MANAGEMENT
Making a diagnosis
- Ask about onset, duration, & associated symptoms e.g. pruritus, pain, vomiting, headache
- Determine the colour of the stools & urine
- Ask about travel history if there is fever, anaemia or thrombocytopaenia
- Find out what medications have recently been taken
- Look for pyrexia, anaemia, hypertension, hepatosplenomegaly
- Test the urine for protein, ketones, urobilinogen & bilirubin
- Take blood for FBC and malaria smear, malaria antigen, U&E, INR, LFT, glucose & hepatitis studies
Treatment
- Determine the cause of the jaundice & treat accordingly
- Discuss management with a senior registrar or consultant
- Call an internal medicine specialist for assistance with causes of jaundice unrelated to pregnancy
- Patients with acute fatty liver & pre-eclampsia/HELLP syndrome require delivery
- Patients with acute viral hepatitis may deteriorate after delivery & should not have labour induced or undergo caesarean section, unless obstetrically indicated