Jaundice During Pregnancy

JAUNDICE DURING PREGNANCY. By Urs Peter Haemmerli. New York, Springer-Verlag, Inc., 1967. 111 pp. $3.80, paperbound. Jaundice During Pregnancy is an excellent monograph which should be read by all internists, obstetricians, and pediatricians, and which should be available in all medical libraries for ready reference. The author concisely summarizes the known minor alterations of the liver and its functioning during normal pregnancy, but points out that abnormal serum transaminases and prothrombin are always indicative of a pathological situation. The author then classifies and masterfully reviews the diseases that cause jaundice during pregnancy. These include viral hepatitis (41%o of all cases), cirrhosis, drug hepatitis, biliary tract disease, pyelonephritis (especially when treated with large doses of intravenous tetracycline), toxemia, and the fatty infiltration of the liver. The way in which pregnancy may modify the course of these diseases (and vice versa) is thoroughly discussed. The author marshalls evidence that tends to demolish the widely held belief that gall stone disease is caused and exascerbated by pregnancy. A sensible discussion of the indications for interrupting pregnancy in the presence of jaundice is given. The author concltudes that interruption is probably only justified in acute fatty infiltration of the liver. The major portion of this monograph is devoted to the review of 132 cases of recurrent jaundice during pregnancy culled from the literature. Only 18 were documented by a liver biopsy, and it is on the basis of these 18 cases that the author discusses the problem and defines the syndrome. The author stresses that this is a benign condition and that the most annoying symptom, pruritis, can now be alleviated by the use of cholestyramine. Perhaps the author's greatest contribution is his insistence on a liver biopsy showing intrahepatic cholestasis coupled with a recurrence of the same syndrome during successive pregnancies as necessary for the diagnosis of intrahepatic cholestasis of pregnancy, since recurrent jaundice during pregnancy may be due to different diseases in successive gestations. The author is to be commended for bringing together a large body of knowledge. Minor criticisms include the absence of a discussion concerning the relationship of recurrent jaundice during pregnancy to the cholestatic hepatitis which occurs following estrogen and/or progesterone therapy. No discussion of the placental origin of the serum alkaline phosphatase that becomes elevated during pregnancy is given. ROBERT L. SCHEIG