A patient at 28 weeks pregnancy presents with low grade fever, malaise, vomiting since 1 week. On examination she is icteric, Her Hb is 10 gm%, bilirubin is 5 mg/dL, SGOT and SGPT at 630 and 600 with normal platelet count. Most probable cause of her jaundice is
**Core Concept**
Jaundice in pregnancy, particularly in the second trimester, can be caused by various factors including viral hepatitis, intrahepatic cholestasis of pregnancy (IHCP), and HELLP syndrome. However, the presence of elevated liver enzymes, particularly SGOT and SGPT, in a patient with icterus and low-grade fever suggests a diagnosis of viral hepatitis.
**Why the Correct Answer is Right**
Viral hepatitis, especially hepatitis A and E, is a common cause of jaundice in pregnancy. The patient's presentation with low-grade fever, malaise, vomiting, and icterus, along with elevated liver enzymes, is consistent with viral hepatitis. The liver enzymes, SGOT and SGPT, are elevated in viral hepatitis due to the inflammation of hepatocytes. The normal platelet count rules out HELLP syndrome, which is characterized by thrombocytopenia. IHCP typically presents with pruritus, and hyperemesis gravidarum does not cause elevated liver enzymes.
**Why Each Wrong Option is Incorrect**
**Option A:** Intrahepatic cholestasis of pregnancy (IHCP) typically presents with pruritus, particularly in the third trimester, and is not associated with elevated liver enzymes. The patient's presentation does not match IHCP.
**Option C:** Hyperemesis gravidarum is a condition of severe nausea and vomiting, but it does not cause elevated liver enzymes or jaundice. The patient's liver enzyme levels and icterus suggest a different diagnosis.
**Option D:** HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet count. The patient's normal platelet count rules out HELLP syndrome.
**Clinical Pearl / High-Yield Fact**
In patients with jaundice in pregnancy, it is essential to consider viral hepatitis as a possible diagnosis, especially in the second trimester. The presence of low-grade fever, malaise, vomiting, and elevated liver enzymes should raise suspicion for viral hepatitis.
**✓ Correct Answer: B. Viral hepatitis**