DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194384

A clinical study on fetomaternal outcome in jaundice with pregnancy

Jigisha P. Padh, Sapana R. Shah, Rupa C. Vyas, Purvi M. Parikh

Abstract


Background: Jaundice in pregnancy and pregnancy in women with preexisting liver disease is not very uncommon. However it takes a major toll on health of both mother and fetus, due to increased morbidity and mortality for both mother and fetus, categorizing pregnancy as a high risk one. The distribution of jaundice in pregnancy varies throughout the world, but is seen more in developing countries. The course and outcome of liver disorder in pregnancy is altered due to various hemodynamic, hormonal and immunological changes unique to pregnancy. The hepatic functions during pregnancy are affected by increase in serum estrogen and progesterone levels.

Methods: This was a prospective study of 70 cases of pregnancy with jaundice admitted in the department of obstetrics and gynecology at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India. The duration of study was from June 2015 to December 2018. During this period 70 patients were admitted with jaundice in pregnancy. Patients were analyzed with regards to socio demographic profile, investigations, maternal and perinatal outcome.

Results: The incidence of pregnancy with jaundice in present study was 0.32%. Most common cause identified was viral hepatitis in 27 cases (38.57%) out of which 23(32.85%) cases being hepatitis E. Followed by HELLP syndrome, pre eclempsia, eclempsia in 24(34.28%) cases. 13(18.57%) cases were belonged to cholestatic jaundice of pregnancy. Rest 6(8.56%) cases belonged to malaria, portal hypertension due to liver disease etc. Out of total 70 patients 53(75.71%) women from rural area, 54(77.13%) patients were from age group of 20-29years.Maximum patients were multigravida i.e. 28 (40%) and 66(94.28%) women coming from lower middle and lower socio economic class. There were 9 maternal deaths, 5 due to DIC. Total vaginal deliveries were 40, 24 patients underwent LSCS, 4 patients had abortion, and 2 expired undelivered. Most common complication was DIC in 16(22.85%) cases and thrombocytopenia in 14(31.67%) cases. 30(42.85%) babies were LBW and 18(25.7%) babies were IUGR.

Conclusions: Prompt diagnosis and accurate evaluation and multidisciplinary approach of management in pregnancy with jaundice at a tertiary care center with good NICU is helpful in reducing maternal and perinatal mortality and morbidity.


Keywords


DIC, Hepatitis E, HELLP syndrome, Jaundice, Perinatal outcome

Full Text:

PDF

References


Ian Donald’s Practical Obstetric Problems; 7th Edition; Liver disorders. Woltes Kluwer India Pvt Ltd, 2014:226-238.

Tripti N, Sarita A. Fetomaternal outcome in jaundice during pregnancy. J Obstet Gynecol India. 2005;55:424-7.

Khuroo MS. Hepatitis E. The enterically transmitted non-A, non-B hepatitis. J Gastroenterol. 1991;10:96- 100.

Satia MN, Jandhyala M. A study of fetomaternal outcomes in cases of jaundice at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2016;5:2352-7.

Mitta P. Fetomaternal outcome in jaundice complicating pregnancy. J Dental Med Sci. 2016;15:72-6.

Ambreen A, Ahmed F, Sheikh A. Jaundice in pregnancy: a clinical study at Fatima Memorial System. J South Asian Fed Obst Gynae. 2015;7(1):22-5.

Nath J, Bajpayi G, Sharma R. A clinical study on jaundice in pregnancy with special emphasis on fetomaternal outcome. IOSR J Dental Medical Sci. 2015;14:116-9.

Acharya N, Acharya S, Shukla S. Study of jaundice in pregnancy. Global J Med Research Gynecol Obst. 2013;13(2):216-20.

Serrano MA, Rites D, Larena MG, Monte MJ, Bravo MP, Oliviera N. Beneficial effect of ursodeoxycholic acid on alterations induced by cholestasis of pregnancy in bile acid transport across the human placenta. J Hepatol. 1998;28: 829-39.