ACUTE ONSET JAUNDICE DURING THIRD TRIMESTER OF PREGNANCY: DIAGNOSTIC DILEMMA- SEPSIS /HELLP SYNDROME

Vinodhini K, Paapa Dasari, Dilip K Maurya, Haritha Sagili

Abstract


Management of pregnant women with acute onset of Jaundice is an Obstetric Challenge because of its obscure etiology and high maternal and perinatal morbidity and mortality. The management of two pregnant women with acute onset of Jaundice during the third trimester is presented as difficulties were encountered in arriving at the etiology.

The first woman was a 32 year old primigravida at 31 weeks of gestation with fever and jaundice of 4 days duration with negative viral markers. Her serum bilirubin was 11.6 mg/dl and WBC count was 20,990 /mm3.  She developed hypertension with hypertensive choroidopathy during the next 24 hrs and underwent Emergency LSCS for nonreactive NST and poor BPP. Her postoperative course was stormy requiring massive transfusion and ventilation for 8 days and prolonged ICU care. She ultimately developed Diabetes and there was evidence of chronic pancreatitis after 3 weeks of delivery.

The second woman was a 22 year old primigravida at 36 weeks of gestation with fever and Jaundice of 2 days duration with negative viral markers. Her bilirubin was 16 mg/dl and WBC count was 26,320/mm3.She had mild hypertension and grade 1 Hypertensive retinopathy and had normal vaginal delivery after labour induction.  She developed fulminant hepatic failure with sepsis and AKI, deranged coagulation profile and suffered from large vaginal haematomas and severe anaemia within 72 hours of delivery and was managed effectively with massive transfusion, tranexamic acid and antibiotics.


Keywords


Jaundice, Third trimester, DIC, Chronic Pancreatitis, Diabetes

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References


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