Jaundice in Pregnancy: A Diagnostic and Management Dilemma

Background: Jaundice in pregnancy is an uncommon but potentially life-threatening clinical condition that presents significant diagnostic and therapeutic challenges. The incidence ranges from 0.1% to 3% of pregnancies, yet it is associated with considerable maternal and perinatal morbidity and mortality. The etiology of jaundice during pregnancy is diverse and may be broadly classified into pregnancy-specific liver disorders and conditions unrelated to pregnancy. Pregnancy-specific causes include intrahepatic cholestasis of pregnancy (ICP), preeclampsia with severe features, HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), and acute fatty liver of pregnancy (AFLP). Non-pregnancy-related causes encompass viral hepatitis (A, B, C, E), drug-induced liver injury, gallstone disease, and autoimmune or metabolic liver disorders. Viral hepatitis, particularly hepatitis E in endemic regions, remains a major contributor to maternal mortality in developing countries. Clinical presentation varies from mild pruritus with elevated bile acids in ICP to fulminant hepatic failure in AFLP. Overlapping symptoms such as nausea, vomiting, abdominal pain, and elevated liver enzymes complicate timely diagnosis. Therefore, a systematic approach including detailed history, clinical examination, laboratory investigations, imaging studies, and multidisciplinary collaboration is essential. Management depends on the underlying cause, gestational age, and severity of maternal and fetal compromise. While ICP is primarily managed medically with ursodeoxycholic acid and planned early delivery, conditions such as HELLP syndrome and AFLP often necessitate urgent delivery irrespective of gestational age. Supportive care, intensive monitoring, and timely referral to tertiary care centers significantly improve outcomes. Early recognition, prompt differentiation between etiologies, and individualized management strategies are critical in reducing adverse maternal and fetal outcomes. Thus, jaundice in pregnancy remains a diagnostic and management dilemma requiring vigilant clinical assessment and coordinated care. Conclusion: Jaundice in pregnancy is an uncommon but potentially life-threatening condition associated with significant maternal and fetal morbidity and mortality. The wide spectrum of etiologies—ranging from pregnancyspecific liver disorders to infectious and medical causes—makes early diagnosis challenging. In this study of 64 patients, viral hepatitis emerged as the most common cause, while pregnancy-specific conditions such as intrahepatic cholestasis of pregnancy, HELLP syndrome, and acute fatty liver of pregnancy were associated with increased maternal complications and adverse fetal outcomes.