Fetomaternal outcome and raised bilirubin level in pregnancy

Abstract

Background: Jaundice in pregnancy has potentially serious consequences for maternal and fetal health. The cardinal features of hepatobiliary disease may include jaundice, pruritus, abdominal pain; nausea, vomiting, and a variety of liver biochemical test abnormalitiesChallenges involve making the diagnosis and the methods of treatment and their safety for both the mother and the baby.

Methods: Based on inclusion criteria, 120 pregnant women were selected from Department of Obstetrics & Gynecology, MGMMC and MYH Indore from 1Aug 2014 to 1^st August 2015.Patients were categorized according to serum bilirubin level. Basic investigations done and associated complications studied and correlated according to the severity and degree of jaundice.

Results: 60% of the patients were aged between 20 and 30 years. 54% were primigravida. 83.3% lived in rural areas while 74.27% came in emergency. Maternal mortality was found highest in the third trimester and when the serum bilirubin crossed 5mg/dl. 43.34% patients with jaundice developed acute kidney injury with serum creatinine level above the cut-off. INR was deranged in 47.5% of the patients. The most common complication seen in our study group was that of HELLP closely followed by multi organ dysfunction and encephalopathy. 67% of the patients delivered vaginally, while 20% went under LSCS. Maternal mortality was 32.5% and perinatal outcome was poor with 50% mortality and 25% nursery admission. 62% of the patients who died were referred from a peripheral health centre.

Conclusions: Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. Better identification and treatment of mothers and fetuses at risk may have far-reaching implications for maternal and child health. Monitored intensive care gives a long term pay off in the maternal and fetal outcome.