Severe jaundice during pregnancy

Severe jaundice during pregnancy is exceptional; it rapidly compromises the maternal and fetal prognosis. The series of seven cases presented in this study (3 acute viral hepatitis, 3 acute steatosis of pregnancy, one uncertain diagnosis), demonstrates the rapid evolution and the major repercussion on the pregnancy (5 premature deliveries, four fetal deaths in 8 children). No maternal death occurred but the complications were practically constant (4 severe haemorrhages, 3 acute renal insufficiencies, one encephalopathy with convulsions). This study permits also to emphasize the difficulty of the diagnosis in the acute phase: laboratory tests are often not very significant and the needle biopsy of the liver is usually contra-indicated; a liver scan (3 cases) may be an interesting alternative. The treatment requires a collaboration between obstetrician and anesthetist. The obstetrical management rests on the condition of the fetus and the etiology since the current tendency is to deal rapidly with the pregnancy, in the presence of an Acute Steatosis.