Space-time clustering of people who fall acutely ill with jaundice, then slip into coma and death, is an alarming phenomenon, more markedly so when the victims are mostly or exclusively pregnant. Documentation of the peculiar, fatal predisposition of pregnant women during outbreaks of jaundice identifies hepatitis E and enables construction of its epidemic history. Between the last decade of the 18th century and the early decades of the 20th century, hepatitis E-like outbreaks were reported mainly from Western Europe and several of its colonies. During the latter half of the 20th century, reports of these epidemics, including those that became serologically confirmed as hepatitis E, emanated from, first, the eastern and southern Mediterranean littoral and, thereafter, Southern and Central Asia, Eastern Europe, and the rest of Africa. The dispersal has been accompanied by a trend towards more frequent and larger-scale occurrences. Epidemic and endemic hepatitis E still beset people inhabiting Asia and Africa, especially pregnant women and their fetuses and infants. Their relief necessitates not only accelerated access to potable water and sanitation but also vaccination against hepatitis E.

Fatal outbreaks of jaundice in pregnancy and the epidemic history of hepatitis E.

A hospital based observational study was carried out on pregnant women presenting with either acute hepatitis or fulminant hepatic failure (FHF), during the past years. Of 53 patients, 20 (38%) developed FHF.Non-A, Non-B was the commonest cause (62%) followed by hepatitis B in 17% and hepatitis A in 4% cases. Eight women expired (case fatality rate 15%) with a high maternal mortality (62%) caused by NANB hepatitis. Perinatal mortality was 30%. Poor prognostic factors identified were lack of antenatal care, severity of jaundice, history of somnolence, gastrointestinal bleeding and a high grade of encephalopathy.

/pdf/prevalence-and-severity-of-viral-hepatitis-in-pakistani-2s505iiamm.pdf

Prevalence and severity of viral hepatitis in Pakistani pregnant women: a five year hospital based study.

This prospective interventional study was carried out on 40 intrapartum jaundice patients admitted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital during January to December 2004. The purpose of the study was to evaluate the effectiveness of prophylactic intrauterine hydrostatic balloon/condom temponade in addition to other conventional methods to prevent and control postpartum haemorrhage in patients with jaundice, to detect the prevalence of different etiological agents responsible for jaundice and to assess the foeto-maternal outcome in this study group. Prophylactic intrauterine hydrostatic balloon temponade was inserted in all of the 40 cases which showed an excellent effectiveness in preventing postpartum haemorrhage in patients with jaundice. The study also showed increased prevalence of Hepatitis E virus (HEV) and a high proportion of perinatal deaths in the study population. DOI: 10.3329/jbcps.v26i1.4229 J Bangladesh Coll Phys Surg 2008; 26: 22-25

/pdf/balloon-temponade-to-prevent-primary-pph-in-jaundice-a-24rpy43kkq.pdf

Balloon Temponade to Prevent Primary PPH in Jaundice - A Prospective Study

Background: Pregnancy with jaundice is considered a high-risk pregnancy. It is the most usual health complaint in pregnant women found more often in developing countries than in developed ones. Jaundice can be concurrent with 1st trimester due to pathological infection for instance viral hepatitis or gall stones or due to the drug administered during pregnancy. These patients may feel better if initial diagnosis and suitable management are provided. This present study intended to evaluate the clinical profile & complications of jaundice during pregnancy. Material & Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2012 to June 2012. A total (N=50) of pregnant women with symptoms of jaundice were enrolled in the study. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 16.0. Descriptive inferential statistics were performed to determine the results of this study. Results: Among the study population (N=50), the majority of patients (34, 68.0%) age were between 20 to 24 years. The mean gestational age of patients was 35.3±3.2 weeks and twelve patients (12, 24.0%) underwent caesarean delivery. Based on clinical features, twenty-seven respondents (27, 54.0%) had mild jaundice, fourteen respondents (14, 28.0%) had moderate jaundice & about one-fifth of the patients (9, 18.0%) had severe jaundice. Fifteen pregnant (15, 30.0%) women had a fever, around two-fifth of the patients (19, 38.0%) had vomiting, pruritus in one patient (1, 2.0%), vaginal bleeding in twelve patients (12, 24.05), & more than half of the patients (27, 54.0%) had ruptured membrane. The causes of jaundice during pregnancy were viral hepatitis in forty-three patients (43, 86.0%). The majority of the patients (27,54.0%) had serum bilirubin less than 10mg, fourteen patients (14,28.0%) had 10 to 15mg of serum bilirubin & only one patient (1,2.0%) had serum bilirubin more than 20mg. SGOT & SGPT was found 100-500 IU/ml in twenty-three patients (23,46.0%) & 500-1000 IU/ml in ten patients (10,20.0%). Alkaline was raised in eighteen cases (18, 36.0%) Based on maternal complications, the majority of patients (31, 62.0%) had a postpartum haemorrhage, and ten patients (10, 20.0%) experienced encephalopathy. Thirty-eight babies (38, 76.0%) were born alive, intrauterine death was in seven cases (7, 14.0%), and stillborn in five cases (5, 10.0%). Conclusion: Hepatitis E was the most common cause of viral hepatitis in our study. Major complications were postpartum haemorrhage and encephalopathy. This study also prevailed, jaundice in pregnancy is related to an increase in maternal mortality and morbidity, obstetric complications, and perinatal complications.

/pdf/clinical-profile-laboratory-parameters-complications-in-2wtre5ec.pdf

Clinical Profile, Laboratory Parameters & Complications in Pregnancy with Jaundice: A Study in DMCH, Dhaka, Bangladesh

Objectives: To describe causes, sociodemographic characteristics, and prevalence of some factors that could participate in the occurrence of jaundice during pregnancy in Alexandria Egypt. Methods: A descriptive study started January 2005 for one year duration, included 20 cases (all cases admitted to Alexandria Fever Hospital and Shatby University Hospital for Obstetrics and Gynecology with the clinical and laboratory diagnosis of jaundice). Questionnaire sheet administered through an interview with each patient includes demographic data, known risk factors, and medical history. Full clinical and obstetric examination was done, with an ultra-sound review, estimation of serum ALT, AST, alkaline phosphatase, bilirubin (total and direct), and serological screening against virus hepatitis A, B, C and E. Results: Most cases (n=17) were admitted to the Fever Hospital. Of them; 11 cases (55%) were due to HAV infection, 5 cases resulted from other virus hepatitis. Remaining 4 cases were due to conditions related to pregnancy. Age between 20 and 30 represented 80% of cases. Low social score accounts for 70% of cases. Only 7 cases presented during the 1st trimester. Most cases got no previous history of jaundice (95%); only 4 cases got family history of jaundice. The majority of cases (65%) reported one or more virus known hepatitis risk factors; suffers anaemia (55%), hepatomegaly (90%), and got abnormal levels in blood chemistry. Conclusions: The study is an update in current causes, demographic pattern, and risk factors associated with clinical jaundice during pregnancy. It documents that many factors are implicated in the causation of this relatively uncommon clinical condition.

https://jhiphalexu.journals.ekb.eg/article_22519_ba26adf10e79c14915d39e4ff374d12a.pdf

Jaundice among Pregnant Women in Alexandria – Egypt: A Descriptive Study

In a study on jaundice during pregnancy it was observed that the incidence of jaundice in pregnancy was 1 in 429. Majority of the cases were primigravida, 70% of cases were between 20 and 30 years of age, 60% of the patients were unbooked, 25% of cases were with severe degree of jaundice in respect to serum bilirubin level and 70% cases were with anaemia. There were preponderance of cases in 3rd trimester. Majority of the cases (60%) had jaundice-delivery interval of above 4 weeks. Among the causes virus hepatitis was commonest one (80%). Maternal mortality was recorded as 1 in 20 cases and perinatal mortality was 7 in 17 births (41%).

Jaundice in pregnancy: a clinical study.

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Jaundice in pregnancy: a clinical study.