Gayathri, S (2013) Maternal and fetal outcome in jaundice complicating pregnancy. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: The incidence of jaundice in India varies from 0.4 to 0.9/1000 deliveries. Jaundice in pregnancy carries a grave prognosis for both the mother and the fetus , and is responsible for 10% of maternal deaths. Liver disease in pregnancy is an important medical disorder seen more often in developing countries than in developed ones. The present study analyzes the causes and the fetomaternal outcome in pregnancies affected with jaundice. Abnormal liver test results are obtained in 3% to 5% of pregnancies because of many potential causes and the clinical outcomes ranges from self-limiting to rapidly fatal. The main causes for abnormal liver tests in pregnant patientsare: (1) Pregnancy-related liver disease. These are the common reasons for abnormal liver function tests in pregnancy. Five liver diseases unique to pregnancy includes the following - (i) Hyperemesis gravidarum (HG), (ii) Intrahepatic cholestasis of pregnancy (ICP), (iii) Preeclampsia, (iv) Hemolysis, elevated liver enzymes, and low platelets (HELLP), (v) Acute fatty liver of pregnancy (AFLP). (2) Newly acquired liver diseases like acute viral hepatitis, drug induced liver injury, or gallstones. (3) Preexisting chronic liver disease such as cholestatic liver disease, autoimmune hepatitis, Wilson disease, and chronic viral hepatitis. (4) physiologic changes in pregnancy - Abnormal liver function test due to physiological changes in pregnancy without liver dysfunction have a unique pattern. The common maternal complications encountered are Encephalopathy, Disseminated intravascular coagulation , Renal failure , Shock, Postpartum hemorrhage, Pyrexia and also Death. AIMS AND OBJECTIVES: 1. To analyze the maternal outcome in terms of mode of termination of pregnancy, maternal complications and mortality of jaundice complicating pregnancy. 2. To identify the relation of maternal morbidity and mortality in relation to admission serum bilirubin level. 3. To assess fetal outcome by perinatal mortality and morbidity. 4. To identify the various etiologies and distribution of jaundice with reference to age , parity and trimesters. Inclusion criteria : pregnant women affected by jaundice treated in Government Rajaji Hospital, Madurai. Exclusion criteria : jaundice in pregnant women occurring due to septic Etiology. MATERIALS AND METHODS Sixty five women with jaundice complicating pregnancy admitted and treated at Government Rajaji Hospital, Madurai from september 2011 to september 2012 were studied. • A detailed history including patient’s age, socioeconomic status, booking, parity and details of menstrual history to arrive at the expected date of delivery was obtained. • Patients were enquired in detail about their complaints and duration like nausea, vomiting, pruritus , anorexia , yellow coloured urine, pale stools, edema legs, bleeding tendency, joint pain, fever and others. • Past history of jaundice especially in previous pregnancy and history of blood transfusion were elicited. • systemic and obstetric examinations were carried out. • Investigations included liver function tests, serum billirubin, SGOT, SGPT, alkaline phosphatase, Viral markers, prothrombin time (PT), partial thromboplastin time (PTT), bleeding time (BT), clotting time (CT), platelet count and ultrasound abdomen were carried out as and when required. • HIV screeing was done in all patients. • Medical gastroenterologist opinion was obtained for all cases. • Labour was closely monitored. Jaundice perse was not an indication for cesarean section. Vaginal delivery with close monitoring was preferred and cesarean sections were done only for obstetric indication. After cross matching fresh blood was kept ready as alteration in coagulation profile was expected in jaundice complicating pregnancy. • Atonicity was managed with oxytocin drip, injection methergin and injection 15 methyl PGF2α. • Patient were kept in the labour ward for close observation. Clotting time was repeated hourly if it was prolonged till it becomes normal. • Soon after delivery all babies were assessed by paediatrician. Alive or dead, sex, gestational age at birth, weight, apgar score and presence or absence of any congenital anomalies were looked for and noted. As per paediatrician opinion sick babies were admitted in preterm ward for intensive care. • Of the 65 women, 28 had viral hepatitis, 8 AFLP, 6 HELLP, 3 cholestatic, 1 hyperemesis, 1 haemolytic anaemia , 1 cirrhosis and 1 Gilberts. • The maternal outcome was noted in terms of the mode of termination of pregnancy, maternal complications and maternal mortality. The relation of maternal morbidity and mortality to the admission serum bilirubin level was analysed. • To identify the various etiologies and distribution of jaundice with reference to age , parity and trimesters. • Fetal outcome was assessed by perinatal morbidity and mortality RESULT: The incidence of jaundice in India varies from 0.4 to 0.9/1000 deliveries. According to this study the incidence of jaundice is 2/1000 deliveries. Singh et al 1 reported 1.03/1000 incidence while Kamalajayaram and Rama Devi 2 reported 0.4/1000 incidence. Of the 65 women studied 58.5% were in 21 to 25 yrs of age (TABLE 1). Mean age is 23 yrs. About 47.7% were primi and 41.5% were second gravida ( TABLE 3 ). 70.7% were in third third trimester (TABLE 4). CONCLUSION: Jaundice in pregnancy is associated with high maternal and perintal mortality rates. Viral hepatitis is the leading cause of jaundice according to our study with hepatitis E being the predominant virus. Hepatic encephalopathy and renal failure are the two important maternal complications. Hepatic encephalopathy is the common cause of death according to our study. According to this study the initial bilirubin level at admission > 10 is associated with poor maternal outcome and high maternal mortality. The factors responsible for a high maternal mortality in our country may be poor nutrition and hygiene, prevalence of anemia, delay in seeking medical advice, and delay in referral to the hospital. Many of the patients when brought to the tertiary health care system are already in moribund condition and often, do not respond to treatment.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Maternal and fetal outcome ; jaundice ; complicating pregnancy. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Dec 2017 03:10 |
| Last Modified: | 05 Dec 2017 03:10 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4257 |
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