Jaundice in pregnancy/neonatal jaundice

Question 1

Bilirubin is derived from…

Answer 1

Breakdown of haemoglobin

Question 2

What process of bilirubin metabolism takes place in the liver?

Answer 2

Conjugation with glucuronic acid to make it water soluble

Question 3

In what forms is bilirubin excreted? (2)

Answer 3

Urobilinogen (excreted by kidneys)

Stercobilinogen (excreted in faeces)

Question 4

Potential causes of jaundice in pregnancy (4)

Answer 4

Intrahepatic cholestasis of pregnancy
Acute fatty liver of pregnancy
HELLP syndrome
Viral hepatitis

Question 5

Jaundice, pruritus, elevated bilirubin and dark urine

Answer 5

Intrahepatic cholestasis of pregnancy

Question 6

Intrahepatic cholestasis of pregnancy- treatment (2)

Answer 6

Ursodeoxycholic acid

Vitamin K if prothrombin time prolonged

Question 7

Why is vitamin K prescribed in Intrahepatic cholestasis of pregnancy

Answer 7

Cholestasis leads to impaired fat absorption; vitamin K is fat soluble

Question 8

Abdominal pain, raised ALT and jaundice

Answer 8

Acute fatty liver disease of pregnancy

Question 9

When is neonatal jaundice always pathological?

Answer 9

If it occurs within the first 24 hours

Question 10

Mechanism of physiological jaundice of the newborn (2)

Answer 10

Increased bilirubin production and immature conjugation pathway

Question 11

In which group of babies is physiological jaundice more common?

Answer 11

Breast fed babies