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

Abstract

A bstract Background Epidemiology of liver disease in obstetric patients shows geographical variation depending upon the prevalence of preeclampsia, viral hepatitis, and tropical vector-borne diseases like malaria, leptospirosis, etc. We undertook the current systematic review to analyze the causes of hepatic dysfunction in obstetric patients in India and identify the gaps in the literature and reporting. Materials and methods We did a systematic review of studies reporting the causes of hepatic dysfunction in obstetric patients in India. A methodological quality assessment was done using a five-point questionnaire. Results A total of 21 studies qualified for evaluation. The rate of hepatic dysfunction among obstetric patients in India ranged from 0.15 to 3.3% with a mean and median rate of 1.49 and 0.93%, respectively. Preeclampsia/HELLP (mean = 36.0%, median = 31.4%, range: 3.6–83.8%) and viral hepatitis (mean = 34.1%, median = 35.5%, range: 5.1–61.8%) were the commonest causes of hepatic dysfunction. Other causes were intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, tropical fever (malaria, leptospirosis, dengue, scrub typhus), etc. Maternal mortality ranged from 1.4 to 40% (mean = 12.6%, median = 10.0%) and perinatal mortality was between 16.4 and 38.70% (mean = 31.75%, median = 35.5%). Conclusion There is moderate quality evidence to show that preeclampsia/HELLP and viral hepatitis are the commonest causes of hepatic dysfunction in obstetric patients in India. How to cite this article Ahmed A, Saxena S, Pandey A, Mishra P, Azim A. Analysis of Causes of Hepatic Dysfunction in Obstetric Patients in India: A Systematic Review. Indian J Crit Care Med 2022;26(1):114–122.

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

“…The etiologies of abnormal LFTs vary across different studies. Recently, a systematic review showed that HDP (mean=36.0%, median=31.4%, range=3.6%-83.8%), viral hepatitis (mean=34.1%, median=35.5%, range=5.1%-61.8%), and IHCP (mean=16.9%, median=15.0%, range=1.2%-54.9%) were the three most common causes of liver dysfunction in pregnancy [ 5 ]. A relatively higher incidence of IHCP was seen in studies by Dsouza et al (54.9%) and Kohli et al (35.6%) where the diagnosis of IHCP was made on clinical grounds, similar to our study [ 13 , 14 ].…”

“…Generally, studies with viral hepatitis or HDP as the main etiology are associated with higher mortality than studies with IHCP as the main etiology. In a systematic review of 21 studies from India, the mean maternal mortality rate was shown to be 12.6% in patients with abnormal LFTs [ 5 ]. 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.…”

“…Maternal mortality in patients with hepatic dysfunction ranges from 1.37% to 39.3%. Similarly, perinatal mortality in patients with abnormal LFTs ranges from 16% to 38% [ 5 ]. Such patients require proper evaluation and timely management to reduce maternal and fetal morbidity and mortality.…”