Liver Disorders in Pregnancy- A Retrospective Study

Abstract

Introduction: Liver disorders associated with pregnancy are important medical disorders that carries grave prognosis and challenging for both obstetricians and hepatologists. It affects about 3% of pregnancies worldwide and about 3-5% pregnancies in India. It can present with various symptoms like yellowish discolouration of sclera, dark coloured urine, anorexia, nausea, vomiting, abdominal pain etc. The liver disorders unique to pregnancy includes-hyperemesis gravidarum, preeclampsia, eclampsia with liver dysfunction, Haemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome, Intrahepatic Cholestasis of Pregnancy (IHCP) and acute fatty liver of pregnancy. Aim: To evaluate demographic variables, causes of liver dysfunction during pregnancy and foeto-maternal outcome of pregnancies complicated by jaundice and liver dysfunction. Materials and Methods: This was a retrospective hospital based observational study on the pregnant women admitted with jaundice or any liver disorders in Department of Obstetrics and Gynaecology in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, over a period of one year from March 2018 to February 2019. The incidence of liver disorders in pregnancy, its causes, the foetal outcome in terms of preterm birth, stillbirth, Foetal Growth Restriction (FGR) and Intrauterine Foetal Death (IUFD), the maternal outcome in terms of mode of delivery, complications, need for Intensive Care Unit admissions and maternal mortality were evaluated. Descriptive statistics like percentage and mean calculation were used to interpret the data. Results: Out of 8264 obstetrics admissions, 126 had liver disorder in pregnancy, incidence being 1.52%. Total 87 (69%) cases were primigravida, 115 (91.3%) cases presented during 3rd trimester of pregnancy, 101 (80.1%) were unbooked for our institution. A total of 92 (73%) were referred to us. Preeclampsia, eclampsia, HELLP syndrome was the most common cause of liver dysfunction accounting for 46.8% followed by IHCP in 31 (24.6%) cases. Out of 126, 115 women admitted in labour, of which 75 (65.3%) delivered vaginally, 38 (33%) taken for caesarean section and two died undelivered. Nine cases were admitted in 1st trimester and two cases in second trimester who did not turn up after discharge. Neonatal mortality was seen in 18 (15.6%). Conclusion: Liver dysfunction in pregnancy carries grave prognosis with high incidence of perinatal and maternal morbidity and mortality. This study emphasises the need for regular Antenatal Care (ANC), need to remain vigilant for preventable causes like haemolytic jaundice, early diagnosis, proper treatment and timely referral of liver disorders with pregnancy to prevent the complications and improve foetal and maternal outcome.

Keywords

• acute fatty liver of pregnancy
• foetal outcome
• intrahepatic cholestasis of pregnancy
• jaundice
• liver dysfunction