Pregnancy specific liver disorders are common, intrahepatic cholestasis is the commonest etiology. This was a prospective study, patients who were admitted to our department with pre-existing liver disease or those suspected to have liver dysfunction on the basis of clinical and laboratory data from AUGUST 2020 to July 2021 were included in our study. During the study period, there were 4638 deliveries in the hospital and 134 pregnant women were diagnosed to have liver disease. Chief complaint associated with liver disease found in this study was pruritus (70%) followed by gastrointestinal symptoms (16.22%), jaundice (5.97%) and asymptomatic (6%). Intrahepatic cholestasis of pregnancy was the most common cause of liver disease (70.14%) followed by hypertensive disorders/HELLP syndrome (14.17%), hyperemesis gravidarum (9.7o%), viral hepatitis (5.22%) and acute fatty liver of pregnancy (0.74%). Early diagnosis, proper maternal and fetal monitoring and timely intervention can prevent adverse maternal and fetal outcome.

The referral system is a core factor in health care delivery system. It plays a crucial role in antenatal care and child bearing by providing access to emergency obstetric care, antenatal and delivery care in primary level facilities. The study was planned to find the cause of patient referred from community health centers, their feto-maternal outcomes and causes of further referral of these patients from our New Medical Collage hospital to further higher referral centers. Methods:The study population consisted of patients referred from Community Health Centers to our Hospital in Government Ambulances and high risk patients referred from our Institute to further higher centers for management. Result: During the study period there were 2785 deliveries out of which 187 were referral. The indications for referral were safe delivery in higher centers (n-38), previous LSCS in labour (n-3o), postdatism (n-25), prematurity (n-15), pregnancy with medical disorders ( 16), and meconium in early labour (n-10), abnormal presentation (n-10), IUD (n-7), TPPROM (n) & early pregnancy loss (23). Outcome of referred patients was 79(42.24%) had caesarean section, 65(34.76%) had normal deliveries, 21(21.22%) had suction & evacuation, 2(1.06%) had laparotomies for ectopic pregnancy, 10(5.34%) patients were discharged and 9(4.81%) patients were further referred to higher centers due to non-availability of ICU and blood components. Conclusion:If we can strengthen the Community Health Centers in term of infrastructure & manpower most of these referrals can be stopped & these patients can be managed at these centers only. If new medical colleges are provided with maternal ICU & blood components most of these patients will not be referred to regional tertiary care centers.