Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: A prospective study from Western India.

Abstract

The aim of this study is to study the etiology, clinical profile, and prognostic factors related to maternal and fetal health in pregnant patients with liver disease in Western India. This study included 103 consecutive pregnant patients with liver dysfunction from August 2013 to July 2015, who underwent regular biochemical tests, viral markers, ultrasound of abdomen, etc. and were followed up for 6weeks postpartum or until death. Pregnancy-specific causes of liver dysfunction were found in 39% (40/103) patients. Liver diseases were most frequent in third trimester 69.9% (72/103). Etiologies in third trimester were viral hepatitis 36.1% (26/72), pregnancy induced hypertension (PIH) 30.5% (22/72), intrahepatic cholestasis of pregnancy 11.1% (8/72), acute fatty liver of pregnancy (2/72), etc. Hepatitis E was the commonest agent among viral hepatitis 71.8% (28/39). Causes of maternal mortality (n = 25) were hepatitis E 40% (10/25), PIH 32% (8/25), and tropical diseases 20% (5/25). Fetal mortality (n = 31) was 38.7% (12/31) in hepatitis E. Maternal mortality was significantly associated with presence of jaundice, fever, abdominal pain, oliguria, anemia, leukocytosis, and coagulopathy. Model for end-stage liver disease (MELD) score >21 predicted maternal mortality with 80% sensitivity and 91% specificity (area under the receiver operating characteristic curve = 0.878 and p < 0.001). Liver disease was most common in the third trimester of pregnancy. Hepatitis E was the most common cause of liver disease in pregnant women in western India with significant maternal mortality, predicted by high MELD score.