JAUNDICE DURING PREGNANCY

Definition

Yellowish discoloration of skin sclera and mucous membrane due to increase bilirubin concentration in the body, is known as jaundice. 

OR

When the serum blirubin level is exceeds 2 mg % due to alteration in bilirubin metabolism. 

INCIDENCE

1-4 per 1,000 deliveries in India.

BILIRUBIN LEVEL 

Total bilirubin level         :- 0.2-1.0 mg/dl

Direct or conjugated bilirubin level :- 0.1-0.4 mg/dl

Indirect or unconjugated bilirubin level :- 0.2-0.7 mg/dl.

TYPES

A) Hemolytic Jaundice

B) Hepatocellular Jaundice

C)  Cholestatic Jaundice

A) Hemolytic Jaundice :- It's occur due to excessive destruction of RBCs. It cause Increase in serum bilirubin Level.

B) Hepatocellular Jaundice:- Hepatocellular Jaundice occur due to damage of liver cells.

C)  Cholestatic Jaundice:- Cholestatic Jaundice is occur due to alteration in flow of bile, unconjugated bilirubin level is high.

CAUSES

• Blood transfusion reactions 
• Sickle cell anemia
• Severe burn
• Pre-Eclampsia, Eclampsia, HELLP syndrome
• Severe bacterial infection
• Chronic hepatitis
• Drug induced
• Cystic fibrosis

CLINICAL FEATURES

• Yellowish discoloration of skin, sclera, mucus membrain.
• Anorexia
• Prurutis
• Restlessness
• Malaise
• Weight loss
• Irritability
• Fatigue
• Clay color stool
• Weakness
• Dark coloured urine

DIAGNOSTIC EVALUATION

• History collection 
• Physical examination
• UST
• LFT
• Blood Investigation 
• Urine Examination
• Liver Biopsy
• Serum bilirubin level
• SGOT/SGPT
• Bleeding time
• Clotting time

MANAGEMENT

Medical Management

• Antibiotic durg :-Prevent from bacteria
• Antihistamine Drug:- Levocetrizine
• Corticosteroid  :- To prevent hemolytic reaction.
• Phenoarbotal :- It increase bile flow.
• Blood transfusion if require 
• Supplementary Iron or folic acid 
• Administration of IV fluid
• Toxic drug avoid

NURSING MANAGEMENT

• Assist vital sign.
• Assess color of skin.
• Liver function test.
• Promote nutritional level. 
• Reduce anxiety level .
• Educate about the disease.