Analytical study to determine the impact of jaundice in pregnancy on maternal and perinatal outcome

Abstract

Background: Jaundice in pregnancy carries a grave prognosis for both the foetus and the mother, and is responsible for 12% of maternal deaths. Liver disease is a rare complication of pregnancy, but when it occurs it may do so in a dramatic and tragic fashion for both the mother and infant. Materials and Methods: Data were collected as prospective Hospital based observational study at tertiary care centre. After the preliminary assessment with regard to the inclusion and exclusion criteria, informed consent was obtained from all patients. Thorough history was taken and physical examination was done. Demographic details of each patient were obtained. Relative investigations were done. Results: Out of 300 patients, 287 were healthy and alive and 13 patients died. The maternal mortality was 4.33%. Out of the total 13 maternal deaths, 4 cases died due to hepatic encephalopathy, 3 due to disseminated-intravascular coagulation and 3 due to sepsis with multiorgan failure. Mortality was due to HELLP- Hemolysis Elevated Liver enzymes and Platelet count in two cases and due to acute fatty liver in one case. In 126 (42%) cases, the mode of delivery was lower segment caesarean section, 138 (46%) cases had normal vaginal delivery, while 36 (12%) cases had undergone abortion. A total of 114 (38%) cases delivered full-term live baby and 78 (26%) cases delivered preterm live baby. Full-term intrauterine foetal death (IUFD) was seen in 15 (5%) cases and preterm IUFD was seen in 69 cases (23%). There was neodeath in 24 (8%) babies. The total perinatal mortality was 36.0%. Conclusion: The present study shows that although liver dysfunction is infrequently seen in pregnancy, it can result in severe maternal and foetal compromise. Jaundice in pregnancy should be managed as a team with the collaboration of the department of obstetrics, internal medicine, gastroenterology, anaesthesia and critical care so that early diagnosis and aggressive management can prevent and reduce foeto–maternal morbidity and mortality.