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Recurrent Jaundice of Pregnancy


Presentation

  • When present, it increases the incidence of acute hepatic failure.[patient.info]
  • Clinical presentation Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy share similar presentations and differentiating between the three entities can be difficult. All present late in pregnancy and can have similar clinical features.[wjgnet.com]
  • The presenting symptom of OC is pruritus, which is more noticeable at night. Researchers are not sure why this is. Other symptoms include dark urine, steatorrhea and, less commonly, jaundice.[rcm.org.uk]
  • Headaches are common, and altered sensorium may be noted on presentation as well.[glowm.com]
  • Published on Nov 14, 2014 Just a presentation about jaundice complicating pregnancy 1. Jaundice in Pregnancy Dr Anusha Rao P 2.[slideshare.net]
Jaundice
  • JAUNDICE DURING PREGNANCY ... - - 17 1) Incidence of jaundice durip. g pregnancy 17 2) Classification of jaundice during pregnancy 17 3) Frequency distribution of different diseases causing jaundice during pregnancy ... ... '. 20 4) Review of literature[books.google.de]
  • , because of jaundice of 2 weeks' . . .[nejm.org]
  • […] of unknown cause but associated with high estrogen levels. intrahepatic cholestasis of pregnancy a type of intrahepatic cholestasis sometimes seen during the third trimester of pregnancy, characterized by severe itching, hepatomegaly, and sometimes jaundice[medical-dictionary.thefreedictionary.com]
  • In its severe form, malaria causes jaundice. There are many possible causes that lead to jaundice after a person has been infected with malaria. Read on for the details.[onlymyhealth.com]
  • ., acute fatty liver of pregnancy, recurrent cholestatic jaundice in pregnancy and jaundice complicating toxemia of pregnancy.[ijrcog.org]
Recurrent Jaundice
  • ALTHOUGH there have been numerous reports in the European literature on a syndrome of recurrent jaundice in late pregnancy we have found only sparse reference to it in the American literature.[nejm.org]
  • Synonym(s): cholestasis of pregnancy , recurrent jaundice of pregnancy . intrahepatic cholestasis of pregnancy Abbreviation: ICP A complication of approx. 1% of pregnancies in which elevated levels of pregnancy hormones cause obstruction to bile flow[medical-dictionary.thefreedictionary.com]
  • Recurrent jaundice caused by recurrent hyperemesis gravidarum. Abstract The existence of jaundice induced by hyperemesis gravidarum is controversial.[gut.bmj.com]
  • Intrahepatic cholestasis of pregnancy Also known as recurrent cholestasis of pregnancy, obstetric cholestasis, cholestasis of pregnancy, recurrent jaundice of pregnancy, cholestatic jaundice of pregnancy, idiopathic jaundice of pregnancy, prurigo gravidarum[dermcoll.edu.au]
  • Svanborg A. (1954) A study of recurrent jaundice in pregnancy. Acta Obstet Gynecol Scand 33 : 434-44. Thorling L. (1955) Jaundice in pregnancy: a clinical study . Acta Med Scand Suppl 302 : 1-123.[rcm.org.uk]
Pruritus
  • […] intrahepatic cholestasis of pregnancy intrahepatic cholestasis with centrilobular bile staining without inflammatory cells or proliferation of mesenchymal cells; clinically characterized by pruritus and icterus; of unknown cause but associated with high[medical-dictionary.thefreedictionary.com]
  • These are deposited within the skin, causing intense pruritus.[flipper.diff.org]
  • […] on pruritus as compared to UDCA monotherapy [ 42 ].[ojrd.biomedcentral.com]
  • Kenyon AP, et al. (2001) Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG 108 : 1190-2.[rcm.org.uk]
  • Pruritus, a primary feature of ICP, is unlikely in these other conditions but also can suggest the possibility of exacerbation of primary biliary cirrhosis.[glowm.com]
Excoriation
  • There is no rash but the skin may show scratch marks (excoriations) or become yellow (jaundiced). This condition typically develops late in pregnancy and resolves within days after the baby is born.[dermcoll.edu.au]
Dark Urine
  • Other symptoms include dark urine, steatorrhea and, less commonly, jaundice. Itching can be intense or mild and there appears to be no correlation between intensity of itch with increased fetal risk.[rcm.org.uk]

Treatment

  • What is the treatment for ICP? Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms.[liverfoundation.org]
  • While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment.[nhs.uk]
  • Treatment and Prevention There's no treatment for jaundice as such, since it's not a disease but a sign of a medical problem. The approach is to treat the underlying cause, if possible.[medbroadcast.com]
  • Usually a lotion (e.g. calamine lotion) with soothing elements is prescribed for this itching and no pills or other drug treatments are needed. Mild itching is common in pregnancy because of the increased blood supply to the skin.[news-medical.net]

Prognosis

  • Jaundice in pregnancy carries a grave prognosis for both the fetus and the mother, and is responsible for 10% of maternal deaths. The present study analyzes the causes and the fetomaternal outcome in pregnancies affected with jaundice.[ijrcog.org]
  • Prognosis Hyperemesis gravidarum is usually a reversible condition with no permanent damage to the liver and almost never fatal.[wjgnet.com]
  • There is generally a favourable prognosis for both mother and baby. Pre-eclamptic liver disease and HELLP See the separate HELLP Syndrome article for further details.[patient.info]
  • Maternal prognosis is good and symptoms resolve rapidly after delivery,accompanied by normalization of serum liver test. ICP recurs during subsequent pregnancies in 45-70% with varying severity of recurrent episodes.[flipper.diff.org]
  • View Article PubMed Google Scholar Laatikainen T, Ikonen E: Fetal prognosis in obstetric hepatosis. Ann Chir Gynaecol Fenn. 1975, 64: 155-164.[ojrd.biomedcentral.com]

Etiology

  • The etiology of this syndrome is unknown, but the clinical and laboratory findings are sufficiently distinctive to separate it from other causes of jaundice.[nejm.org]
  • The cause of ICP is unknown but is thought to be multifactorial with genetic,hormonal and environmental involvement.Family clustering and varying incidence in different geographic regions speaks strongly for a genetic etiology of ICP.[flipper.diff.org]
  • Etiology and pathogenesis The etiology of ICP is not completely understood and is still under discussion. Genetic and hormonal factors, but also environmental factors may contribute to the pathogenesis of ICP [ 1 ].[ojrd.biomedcentral.com]
  • Starvation injury was proposed as an etiology since 1968[ 8, 9 ]. Over expression of cytokine-producing cells was implicated as a potential cause for pregnancy-related liver diseases such as preeclampsia and HG.[wjgnet.com]

Epidemiology

  • Acute fatty liver of pregnancy Epidemiology It is a rare condition with an incidence of 5 in 100,000 pregnancies. [ 8 ] Acute fatty liver of pregnancy (AFLP) tends to occur in late pregnancy. [ 3 ] Risk factors include first pregnancies, pre-eclampsia[patient.info]
  • EPIDEMIOLOGY The incidence of ICP varies widely with geographical location and ethnicity. 1 to 2 pregnancies in 1000 are affected by cholestasis. it is most common in South America, particularly in Chile, where the early reports described an overall incidence[flipper.diff.org]
  • Epidemiology ICP has been observed in almost all ethnic groups, but there is relevant geographical variation in the incidence of ICP [ 1, 4 ].[ojrd.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • […] microvesicular steatosis cannot be detected as well as the more common macrovesicular fatty change, in which imaging is very sensitive. 123 Although the exact mechanism of liver injury still is unknown, great advances have been made in understanding the pathophysiology[glowm.com]

Prevention

  • The gallbladder or its bile ducts can become blocked, preventing excretion of bilirubin into the intestine. Bilirubin will then back up into the liver and then into the bloodstream.[medbroadcast.com]
  • .  Infusion of concentrated glucose solution may be required to treat or prevent hypoglycemia. 26.  Prompt delivery  The route should be guided by obstetric indications.[slideshare.net]
  • Isolate the infected patient to prevent spread. Symptomatic treatment includes maintenance of adequate hydration and nutrition. Pregnant women exposed to the virus can be given immune globulin within two weeks of exposure, together with vaccine.[patient.info]
  • In one study, it was shown to improve not only pruritus but the biochemical abnormalities of ICP. 75 SAMe prevents estrogen-related effects on bile flow and increases detoxification of bile acids by increasing the bioavailability of glutathione. 80–83[glowm.com]
  • This could be mediated by enhanced expression of plasma membrane transporters involved in the excretory role of the placenta and would prevent structural alterations of the trophoblast induced by maternal cholestasis.[flipper.diff.org]

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