Jaundice, detected clinically when bilirubin levels are over 2 mg%, is the manifestation of raised bilirubin in the blood. While liver size does not increase in pregnancy, its location shifts due to uterine enlargement. Functions of the liver are affected by increased estrogen and progesterone levels in pregnancy, resulting in changes to certain enzyme and protein levels. Jaundice in pregnancy can be due to conditions intrinsic or unrelated to pregnancy, including intrahepatic cholestasis which causes pruritus and mild jaundice from elevated bile acids. Treatment focuses on relieving itching and preventing complications.

2. Jaundice is the clinical manifestation of raised
bilirubin levels in blood.
Detected clinically at bilirubin concentration of
2 mg% or more (normal 0.2-0.8mg%)

3.  Outside pregnancy, liver receives up to 23-
55% of cardiac output which does not change
significantly during pregnancy.
 Size of the liver does not increase
 Postero-superior displacement by the
enlarging uterus.

4. PALPABLY ENLARGED LIVER IS ABNORMAL IN
PREGNANCY
Metabolic, synthetic and excretory functions of
liver affected by increased levels of estrogen
and progesterone in pregnancy.

5. Bilirubin Unchanged or slightly decreased
Asparatate transaminase (AST) Unchanged initially but 25%
decrease by 3rd trimester
Alanine transaminase (ALT) Unchanged initially but 25%
decrease by 3rd trimester
Gamma glutamate transaminase
(GGT)
Unchanged or slightly decreased
Alkaline phosphatase 2-4 fold increase in 3rd trimester
Cholestrol Two fold increase
Triglycerides 2-3 fold increase
Globulin Increase in alpha and beta
globulins

6. Jaundice peculiar to the
pregnant state
Jaundice unrelated to
pregnant state
Jaundice when pregnancy
is superimposed on
chronic liver disease
Intrahepatic cholestasis
(Obstetric Cholestasis)
may be recurrent
Viral hepatitis: virus
A,E,G
Chronic hepatitis
Severe pre-eclampsia,
eclampsia, HELLP
syndrome
Gall stone-obstructive
jaundice
Cirrhosis, tumors
Acute fatty liver (acute
yellow atrophy of the
liver)
Drug induced-isoniazid,
phenothiazines
Severe hyperemesis
gravidarum
Hemolytic jaundice-
mismatched blood
transfusion, malaria,
clostridium welchii
infection etc
Endotoxic shock-
disseminated
intravascular coagulation

7. Obstetric cholestasis is a disorder that affects
the liver during pregnancy.
This causes a build-up of bile acids in the
body.

8.  HORMONES
Hormones such as estrogens, levels of which
are higher in pregnancy, may affect the way the
liver works and cause obstetric cholestasis.
 Similar manifestation is also observed in
women taking contraceptive pills. Genetic,
familial and abnormal progesterone
metabolism have been observed.

9.  Itching
Itching can start any time during pregnancy,
but usually begins after 28 weeks. Although it
often starts on the palms of hands and the
soles of the feet, it may spread over arms and
legs.
 Weakness, nausea or even vomiting. Jaundice
is slight
 Rise in the levels of AST, ALT and serum
alkaline phosphatase.

10.  Unexplained itching
 LFT

11.  Preterm labor
 LBW babies
 Meconium stained liquor, IUD
 PPH

12.  Cholestyramine is effective for itching
 Vit K to reduce postpartum hemorrhage and
neonatal bleeding.
 Oral contraceptives should be avoided in
women with history of obstetric cholestasis
 Ursodeoxycholic acid (UDCA) is found helpful.
It increases bile acid excretion.