Non-obstetric causes of jaundice may include drugs, acute cholecystitis, and biliary obstruction by gallstones. Acute viral hepatitis: The most common cause of jaundice during pregnancy is acute viral hepatitis. It may predispose to preterm delivery but does not appear to be teratogenic. Acute viral hepatitis is generally mild, but hepatitis E, common in underdeveloped countries, may be severe. HBV may be transmitted to the neonate immediately after delivery or, less often, to the fetus transplacentally.
Chronic active hepatitis: Chronic active hepatitis, especially with cirrhosis, impairs fertility. When pregnancy occurs, risk of spontaneous abortion and prematurity is increased, but risk of maternal mortality is not.
Cholestasis (pruritus) of pregnancy: This relatively common disorder apparently results from idiosyncratic exaggeration of normal bile stasis due to hormonal changes. Intense pruritus, the earliest symptom, develops during the 2nd or 3rd trimester; dark urine and jaundice sometimes follow. Acute pain and systemic symptoms are absent. The disorder usually resolves after delivery but tends to recur with each pregnancy or with use of oral contraceptives.
Fatty liver of pregnancy: This rare, poorly understood disorder occurs near term, sometimes with preeclampsia. Symptoms include acute nausea and vomiting, abdominal discomfort, and jaundice, followed in severe cases by rapidly progressive hepatocellular failure. Maternal and fetal mortality rates are high in severe cases.
Clinical and laboratory findings resemble those of fulminant viral hepatitis except that amino transferase levels may be< 500 units/L and hyperuricemia may be present. Diagnosis is based on clinical criteria, liver function tests, hepatitis serologic tests, and liver biopsy. Biopsy shows diffuse small droplets of fat in hepatocytes, usually with minimal apparent necrosis, but in some cases, findings are indistinguishable from viral hepatitis.
Preeclampsia: Severe preeclampsia can cause liver problems with hepatic fibrin deposition, necrosis, and hemorrhage that can result in abdominal pain, nausea, vomiting, and mild jaundice. Subcapsular hematoma with intra-abdominal hemorrhage occasionally occurs, most often in women with preeclampsia that progresses to the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).
Chronic hepatic disorders: Pregnancy may temporarily worsen cholestasis in primary biliary cirrhosis and other chronic cholestatic disorders, and the increased plasma volume during the 3rd trimester slightly increases risk of variceal hemorrhage in women with cirrhosis. However, pregnancy usually does not harm women with a chronic hepatic disorder.