A study of spectrum and fetomaternal outcome of Jaundice in pregnant women: an experience from a tertiary referral centre of North India

Abstract

Background: Pregnancy in jaundice is an important Medical disorder, commonly seen in developing countries like India. The objective of the study was to evaluate the causes leading to jaundice in pregnancy and to analyse the feto-maternal outcome in patients of jaundice in pregnancy.Methods: This was a prospective observational study of antenatal cases with jaundice admitted in the Department of Obstetrics and Gynecology, King Georges Medical University, Lucknow over a period of one year after getting approval of ethical clearance. Total 122 cases were enrolled after informed consent.Results: Total of 122 cases were enrolled, Incidence of jaundice in pregnancy was 1.2%. Majority of patients were of age group 20-25 years 48.4%. About 69.7% presented at gestational age of 29-40 weeks. Most common cause was pre-eclampsia 33.6%, followed by cholestasis 23.75% and hepatitis 17.2%. Amongst hepatitis, most common was hepatitis B in 26.7%. Out of 122 cases, 59.8% delivered while 50.2% were undelivered 52.4% patients improved and were discharged while 47.6% patients expired. Vaginal deliveries were 56.1%, abdominal deliveries were 43.9%, and main reason for maternal mortality was hepatic encephalopathy in 64.6%. Mortality was higher in patients with total bilirubin > 10mg%. Perinatal mortality was 37%.Conclusions: Pregnancy complicated with jaundice carries very poor maternal and fetal outcome. Poor outcome may be attributed to delay in seeking medical advice, lack of awareness, lack of proper antenatal checkups 100% ANC booking can help in reducing fetomaternal morbidity and mortality.

Comparing Feto-Maternal Outcomes in Pregnant Women With Normal and Abnormal Liver Function Tests: A Prospective Observational Study

“…Our results showed a maternal mortality rate of 5.5% in our sample, which was similar to studies by Malhotra et al (6.24%) and Bhalla et al (5.9%) [ 16 , 17 ]. Maternal mortality varies widely across different studies, ranging from 1.37% to 39.3% [ 12 , 13 ]. Generally, studies with viral hepatitis or HDP as the main etiology are associated with higher mortality than studies with IHCP as the main etiology.…”

“…Half of the maternal deaths in our study were caused by AFLP alone (33.3%) or associated with HDP (16.6%), and sepsis with or without encephalopathy was responsible for 33.3% of maternal deaths. Viral hepatitis [ 18 ], HDP [ 13 , 15 ], AFLP [ 19 , 20 ], tropical hepatitis [ 21 ], sepsis, and encephalopathy [ 12 , 22 ] were the principal causes of maternal mortality, as described in various other Indian studies. The perinatal mortality rate was 5.56% in our study, which was similar to that reported by Dsouza et al at 5.7% of cases [ 14 ].…”

“…Viral hepatitis [18], HDP [13,15], AFLP [19,20], tropical hepatitis [21], sepsis, and encephalopathy [12,22] were the principal causes of maternal mortality, as described in various other Indian studies. The perinatal mortality rate was 5.56% in our study, which was similar to that reported by Dsouza et al at 5.7% of cases [14].…”

“…According to the Ministry of Health and Family Welfare Department of India during 2016-2018, the maternal mortality rate in India was 0.11% [9]. Many studies have reported different maternal mortality rates due to abnormal LFTs, with a mean value of approximately 12.6% [10][11][12]. Assuming an alpha error of 5%, a study power of 80%, and a lost-to-follow-up rate of 10%, the necessary sample size was calculated to be 59 patients in each arm of the study.…”

Analysis of Causes of Hepatic Dysfunction in Obstetric Patients in India: A Systematic Review

“…Agarwal et al from Lucknow reported the maximum deaths due to hepatic encephalopathy, but arterial ammonia levels were not mentioned in the study. 15 There were no maternal deaths due to intrahepatic cholestasis of pregnancy or hyperemesis gravidarum.…”