A study on jaundice in pregnancy and its impact on maternal and perinatal outcomes in a tertiary care hospital, Bhavnagar
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252743Keywords:
HELLP syndrome, Jaundice in pregnancy, Maternal outcomes, Perinatal outcomes, Viral hepatitisAbstract
Background: Jaundice during pregnancy is a significant clinical condition that affects 3-5% of pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. With viral hepatitis being the predominant cause in developing countries, comprehensive studies examining outcomes in tertiary care settings are essential for evidence-based management strategies.
Methods: A retrospective observational study was conducted at Government Medical College, Bhavnagar, Gujarat, and data taken from April 2022 to April 2023. Fifty antenatal patients with clinical and laboratory evidence of jaundice (serum bilirubin >1.2 mg/dl, liver transaminases >45 IU/l) were enrolled using purposive sampling. Detailed clinical assessment, laboratory investigations including liver function tests, viral serology, and coagulation profiles were performed. Maternal and perinatal outcomes were systematically recorded and analysed.
Results: The study population predominantly comprised women aged 21-29 years (72%) with 56% being primigravida. Viral hepatitis was the leading cause (60%), followed by preeclampsia with HELLP syndrome (32%). Maternal complications included preterm delivery in 54% of cases, with coagulopathy present in 24% and thrombocytopenia in 42%. Neonatal outcomes revealed concerning statistics with 62% low birth weight babies and 18% early neonatal mortality, primarily due to pneumonia (8%) and intrauterine growth restriction (4%).
Conclusions: Jaundice in pregnancy significantly impacts maternal and perinatal outcomes in our tertiary care setting. The high rates of preterm delivery, low birth weight, and neonatal mortality emphasize the critical need for enhanced antenatal surveillance, early detection protocols, and preventive strategies including hepatitis vaccination programs to reduce associated morbidity and mortality.
Metrics
References
Solanke D, Rathi C, Pandey V, Patil M, Phadke A, Sawant P. Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: a prospective study from Western India. Indian J Gastroenterol. 2016;35(6):450-8. DOI: https://doi.org/10.1007/s12664-016-0704-6
Changede P, Chavan N, Raj N, Gupta P. An observational study to evaluate the maternal and Foetal outcomes in pregnancies complicated with jaundice. J Obstet Gynecol India. 2019;69(1):31-6. DOI: https://doi.org/10.1007/s13224-018-1105-9
Parveen T, Begum F, Akhter N. Feto-maternal outcome of jaundice in pregnancy in a tertiary care hospital. Mymensingh Med J. 2015;24(3):528-36.
Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007;147(1):28-33. DOI: https://doi.org/10.7326/0003-4819-147-1-200707030-00005
Duraiswamy S, Sheffield JS, Mcintire D, Leveno K, Mayo MJ. Updated etiology and significance of elevated bilirubin during pregnancy: changes parallel shift in demographics and vaccination status. Digest Dis Sci. 2017;62(2):517-25. DOI: https://doi.org/10.1007/s10620-016-4282-3
Çallıoğlu N, Tuna G, Tandoğan Ö, Ersan F, Atalay S, Bilirer KK. Systemic immune-inflammatory index and platelet-to-lymphocyte ratio in intrahepatic cholestasis of pregnancy. Saudi Med J. 2024;45(11):1217. DOI: https://doi.org/10.15537/smj.2024.45.11.20240760
Kumar N, Das V, Agarwal A, Pandey A, Agrawal S. Fetomaternal outcomes in pregnant women with hepatitis E infection; still an important fetomaternal killer with an unresolved mystery of increased virulence in pregnancy. Turk J Obstet Gynecol. 2017;14(2):106. DOI: https://doi.org/10.4274/tjod.15045
Roy A, Premkumar M, Mishra S, Mehtani R, Suri V, Aggarwal N, et al. Role of ursodeoxycholic acid on maternal serum bile acids and perinatal outcomes in intrahepatic cholestasis of pregnancy. Eur J Gastroenterol Hepatol. 2021;33(4):571-6. DOI: https://doi.org/10.1097/MEG.0000000000001954
Iqbal M, Muhammad Z, Akhter N, Alam SS. Effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes. Cureus. 2024;16(10). DOI: https://doi.org/10.7759/cureus.70800
Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899-909. DOI: https://doi.org/10.1016/S0140-6736(18)31877-4
Vasavan T, Deepak S, Jayawardane IA, Lucchini M, Martin C, Geenes V, et al. Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations. J Hepatol. 2021;74(5):1087-96. DOI: https://doi.org/10.1016/j.jhep.2020.11.038
Zaman K, Julin CH, Aziz AB, Stene-Johansen K, Yunus M, Qadri F, et al. Safety and effectiveness of a recombinant hepatitis E vaccine in women of childbearing age in rural Bangladesh: a phase 4, double-blind, cluster-randomised, controlled trial. Lancet Glob Health. 2024;12(8):e1288-99. DOI: https://doi.org/10.1016/S2214-109X(24)00192-X
Sharma S, Aherwar R, Jawade S. Maternal and fetal outcome in jaundice complicating pregnancy: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2016;5(4):1084-8. DOI: https://doi.org/10.18203/2320-1770.ijrcog20160862
Krishnamoorthy J, Murugesan A. Jaundice during pregnancy: maternal and fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;5(8):2541-5. DOI: https://doi.org/10.18203/2320-1770.ijrcog20162224
Bacq Y. Liver diseases unique to pregnancy: a 2010 update. Clin Res Hepatol Gastroenterol. 2011;35(3):182-93. DOI: https://doi.org/10.1016/j.clinre.2010.11.011
Williamson C, Geenes, V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120-33. DOI: https://doi.org/10.1097/AOG.0000000000000346
Prasad GS, Prasad S, Bhupali A, Patil AN, Parashar K. A study of hepatitis E in pregnancy: Maternal and fetal outcome. J Obstet Gynecol India. 2016;66(Suppl 1):18-23. DOI: https://doi.org/10.1007/s13224-015-0749-y
Hasan RF, Kavitha D, Vasanthamani P, Padmanaban S. Maternal and fetal outcome in jaundice complicating pregnancy. Int J Clin Obstet Gynaecol. 2019;3(2):132-4. DOI: https://doi.org/10.33545/gynae.2019.v3.i2c.22
Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol. 2016;64(4):933-45. DOI: https://doi.org/10.1016/j.jhep.2015.11.030
Girling JC, Dow E, Smith JH. Liver function tests in pre‐eclampsia: importance of comparison with a reference range derived for normal pregnancy. BJOG. 1997;104(2):246-50. DOI: https://doi.org/10.1111/j.1471-0528.1997.tb11054.x
Joshi H, Jeswani AK, Desai SS. A study of materno-fetal outcomes in cases of jaundice during pregnancy. N Indian J OBGYN. 2022;8(2):209-13. DOI: https://doi.org/10.21276/obgyn.2022.8.2.11
Singh S, Yadav P, Lal P, Verma P. Role of liver function tests among pregnant women with respect to feto-maternal outcome in third trimester: an analytical cross-sectional study. Int J Reprod Contracept Obstet. Gynecol. 2025;14(3):862-8. DOI: https://doi.org/10.18203/2320-1770.ijrcog20250519