A study of non infective jaundice in pregnancy

Nandini, P (2018) A study of non infective jaundice in pregnancy. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Pregnancy with jaundice is considered as high risk pregnancy. Jaundice affects a small percentage of pregnant women, yet it takes a major toll on health of both mother and fetus especially in developing countries like India. It complicates 3-5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. Throughout the pregnancy there exists alteration in normal physiological and hormonal profiles. Incidence of jaundice in pregnancy is 0.4-0.9/1000 in India. It could be peculiar to the pregnancy such as acute fatty liver of pregnancy, recurrent cholestatic jaundice in pregnancy and jaundice complicating preeclampsia of pregnancy. It can be concurrent with pregnancy such as due to infective pathology like viral hepatitis and also due to preeclampsia, HELLP, Acute fatty liver in pregnancy, intrahepatic cholestasis in pregnancy, hyperemesis gravidorum, Wilson disease, cirrhosis with portal hypertension or it could be due to drugs administered during pregnancy. The present study analyses the cause of the disease, altered liver function, maternal and fetal morbidity and mortality and preventive measures in jaundice complicating pregnancy. This study will be helpful in better understanding and improving the maternal and perinatal outcome in jaundice complicating pregnancy. AIM OF THE STUDY: 1. Studying the incidence of non infective jaundice in pregnant women in this tertiary care centre. 2. To enumerate the various causes of non infective jaundice in pregnancy. 3. To follow the course of the disease and the numerous complications it Ensues. 4. To form a preplanned algorithm of investigations to diagnose non infective jaundice in pregnancy. 5. To study the best protocol for the management of non infective jaundice in pregnancy. 6. To follow maternal and fetal outcomes in non infective jaundice in pregnancy. MATERIALS AND METHODS: The study was a single institution prospective randomized study conducted in Madurai Medical College over a period of six months. A total of 40 patients were included in the study. All the patients were thoroughly examined and case sheets were written in the same fashion to facilitate comparison. All of them underwent clinical examination and an algorithm of investigations required to approach the diagnosis of non infective jaundice. The patients were subjected to various forms of treatment available in the tertiary care centre. The protocol was approved by the Ethical Review Board of the institute and an informed consent was obtained from all patients. The patients were followed through the course of the disease taking into account the complications of the disease, the management protocols including the obstetric management and blood product transfusion, the maternal and fetal outcomes and the recovery time. The maternal outcome was derived from the rate of complications, ICU stay, recovery interval and maternal mortality. The fetal outcome was studied by the number of live births, NICU admission and perinatal mortality. The patients were followed up for the duration of hospital stay and the recovery time was recorded. PARTICIPANTS: The patients were selected from those attending the obstetric department at the hospital with no specific limitation imposed on age and gestational age. All the patients were diagnosed to have jaundice clinically with the exclusion criteria being infective hepatitis in pregnancy. METHODS: All the patients satisfying the inclusion criteria were carefully evaluated in terms of clinical examination, recording of BP, obstetric examination, laboratory investigations including Hb, platelet, urine albumin, clotting time, renal function test, liver function test, serum uric acid, LDH, viral markers, ultrasonogram. CONCLUSION: HELLP constitutes most of the causes of non infective jaundice, it leads to increased maternal morbidity than mortality. Hence mortality is preventable with early diagnosis. Higher blood pressure reading showed higher risk of complications. Higher bilirubin values and altered LFT were more prone for severe manifestations of the disease. Advanced maternal age at gestation are higher risk of complication. Cirrhosis with portal hypertension was found to be the cause of maternal mortality among all causes of non infective jaundice in a tertiary care centre. Early intervention and delivery of the fetus within 24hrs reduces the incidence of complications and improved prognosis and reduce delivery recovery time. Patients presented with lower BP recovered earlier Preterm babies of affected mothers ran a higher risk of complications.

Item Type:	Thesis (Masters)
Uncontrolled Keywords:	non infective jaundice ; pregnancy.
Subjects:	MEDICAL > Obstetrics and Gynaecology
Depositing User:	Subramani R
Date Deposited:	16 Jul 2018 03:35
Last Modified:	16 Jul 2018 03:35
URI:	http://repository-tnmgrmu.ac.in/id/eprint/8856

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