Publication:

A study of fetomaternal outcomes in cases of jaundice at a tertiary care centre

Background Jaundice in pregnancy is affects a small percentage of pregnant women yet takes a major toll on the health of both the mother and the foetus. The distribution of jaundice in pregnancy varies throughout the world but is seen comparatively more in the developing countries. The course and outcome of liver disorders in pregnancy is altered due to the various hemodynamic, immunological and hormonal changes of pregnancy.

Methods This is a retrospective study conducted in the department of obstetrics and gynecology at Seth G.S. medical college and KEM hospital, Mumbai, Maharashtra, India over one year from January to December 2015. Data of 55 women diagnosed to have jaundice from clinical and biochemical evidences as per records was collected.

Results There were 6780 deliveries; the incidence of jaundice being 0.81%. Most common cause identified was viral hepatitis 34 cases (62%), 24 cases being hepatitis E, followed by cholestasis of pregnancy 13 cases (23.6%) and the rest 8 cases were due to other causes like leptospirosis, malaria, HELLP syndrome, drug induced and chronic liver disease due to portal hypertension.72.7% belonged from the rural set up. 45 patients were referred from peripheral hospitals. Maximum patients were primigravidas and were between the age group 25-29 years of age. 70% babies were low birth weight. 50% babies had intrauterine growth restriction. There were 12 maternal deaths,7 due to hepatitis E. Total vaginal deliveries were 37, 9 patients underwent lower segment caesarean section and 1 patient had instrumental (vacuum) delivery. Most common maternal complication was DIC and postpartum haemorrhage. 18 patients required ICU care, out of which 13 patients were Hepatitis E positive. Ventilator support was required in 73% of the patients admitted to the intensive care unit.

Conclusions Prompt diagnosis, accurate evaluation and a multidisciplinary approach is needed to tackle this high risk pregnancy as it leads to a poor maternal and perinatal outcome.