Abstract

Aim: To assess the foetal outcomes in pregnancies with hepatic dysfunction.

Material and Methods: 100 antenatal patients admitted with abnormal liver function tests were studied in antenatal period, during delivery till the post partum period in tertiary care referral centre.

Results: Most of the patients were primigravida (56%) and the mean age was 23.4 years (21-25 years). The common symptoms were nausea and vomiting (43%) and jaundice at presentation (19%). Pregnancy specific liver diseases accounted for hepatic dysfunction in 66% of cases. The other frequent cause for altered liver function was Viral hepatitis (34%). Post partum haemorrhage (15%), disseminated intravascular coagulation (13%) and abruptio placentae (12%) were the most frequent maternal complications. Maternal mortality was 4% in this study. Delivery occurred preterm in 28%. Low birth weight (< 2.4 kg) and very low birth weight (<1.5 kg) occurred in 19 %and 11% respectively. The perinatal mortality was 24%. Perinatal mortality was more in HELLP[ haemolysis (H), elevated liver tests (EL), and low platelet count (LP) ] (54.2%),  followed by preeclampsia (20.8%) , Hepatitis  (16.7%).Acute fatty liver of pregnancy(4.2%) and ICP (Intrahepatic cholestasis) (4.2% ).

Conclusion: Liver disease in pregnancy carries a bad prognosis and leads to higher maternal (30%) and foetal complications. Pregnancy specific liver diseases were the most common cause for hepatic dysfunction in this study. Maternal mortality was 4% and perinatal mortality was 24% with worst perinatal outcome noted in HELLP syndrome.

Keywords- Hepatic dysfunction, HELLP syndrome, acute fatty liver of pregnancy, intrahepatic cholestasis of pregnancy.

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