JAUNDICE DURING PREGNANCY

Abstract

32 cases of jaundice complicating pregnancy are reported by the Department of Gastroenterology at the Naval Hospital Valparaiso Chile with regard to the clinical aspects of the condition and its effects on the infants health. Intrahepatic cholestasis was diagnosed in 31 patients and choleslithiasis in 1. Jaundice appeared during the third trimester in 75% of the cases and 9 of 19 multipara had expereinced the disease during previous pregnancies--a recurrence rate of 47.3%. 5 patients developed jaundice and pruritus while using oral contraceptives; in 1 case jaundice appeared after only 20 days therapy with lynestrenol 5 mg and mestranol .15 mg. Abdominal pain was the the relevant complaint in 8 cases; urine culture confirmed a urinary infection in 7. Serum alkaline phosphatase levels were high (over 6 Bodansky units) in 24 cases the highest being 17 units. Serum pyruvic and oxaloacetic transaminase levels were elevated over 80 units in 7 cases. Flocculation tests were normal while serum cholesterol levels were under 300 mg in 6 cases between 301 and 400 mg in 17 cases and from 401 to 500 mg in 6 patients. The highest bilirubin level was 7.2 mg per 100 ml. Premature labor occurred in 33.3% of the patients and appears to be the main effect of jaundice on pregnancy. 10 infants weighed less than 2500 gm. 2 fetal deaths occurred; 1 macerated stillbirth and 1 early neonatal death due to respiratory distress syndrome and prematurity. Termination of pregnancy either by induced labor or by caesarean section is recommended for consideration in patients with recurrent cholestasis and a previous history of fetal loss. The studys high incidence of fetal distress (40.6%) also recommends the availability of fetal monitoring for such patients. Oral contraceptives should be avoided in cases of a previous history of cholestatic jaundice of pregnancy.