BackgroundHepatic dysfunction during pregnancy places both the mother and the fetus at risk. Investigations which are efficient, cost effective and easily available for prognostication are required to tackle this global problem. We studied the etiologies and evaluated investigations for predictive efficiency.MethodsOne hundred ninety-seven pregnant women with hepatic dysfunction during pregnancy were identified. All patients were followed up till 8 weeks after termination of pregnancy or death. Clinico-demographic, biochemical and hematological data were collected and analyzed.ResultsOne hundred ninety-seven of 6,122 females had abnormal liver function tests. Pre-eclampsia (57%), eclampsia (19%), HELLP syndrome (8%), viral infection (6%), hyperemesis gravidarum (5%), intrahepatic cholestasis of pregnancy (4%), chronic liver disease (1%) and sepsis were encountered. There were 41 fetal deaths, 42% preterm deliveries, and NICU admission rate was 27%. Five maternal deaths occurred. Maternal anemia, thrombocytopenia, hyperbilirubinemia and coagulopathy were statistically significant in adverse fetal outcomes. Serum bilirubin performed better than INR as a predictor of both maternal and fetal outcomes.ConclusionsHepatic dysfunction during pregnancy is associated with adverse events for both the mother and the fetus and hypertensive disorders remain the major cause. Maternal bilirubin levels and INR have a role in predicting adverse feto-maternal outcome.

AimsThe main purpose of this article is to conduct audit of clinical profile and outcomes of patients presenting with acute variceal bleed in a tertiary care hospital. Methods and Material This was a retrospective study of patients presenting with variceal bleed in a tertiary care center. Data were generated through a computerized electronic record system. Data of patients admitted for acute variceal bleed from August 2018 to December 2018 were collected and considered for analysis. Statistical analysis was done using the software Statistical Package for the Social Sciences (SPSS) 22.0 version. Results Overall, 107 cases were analyzed. In 89.7% (96) cases, cirrhosis of liver was a cause of variceal bleed. Besides, 77.6% (83) patients had large esophageal varices. Five patients (4.7%) required glue injection. Rebleed rate in present study was 0.9%. Mortality due to variceal bleed was 9.3% (10). Acute rebleed (p = 0.002), low mean arterial pressure (MAP; p = 0.001), low platelet count (p = 0.001), high serum creatinine (p = 0.001), high serum total bilirubin (p = 0.001), high international normalized ratio (INR; p = 0.001), and higher model for end stage liver disease (p = 0.001) were associated with increased risk of mortality. Door to endoscopy time (<12 hours or 12-24 hours) did not affect the mortality rate (p = 0.699). Terlipressin given 24 hours after endotherapy is equally effective as terlipressin given 5 days after endotherapy. Conclusion Mortality due to acute variceal bleed can be reduced with timely intervention. Low MAP, low platelet count, higher serum bilirubin and creatinine, and higher INR are predictors of increased mortality due to variceal bleed. Endoscopy done within 12 to 24 hours of presentation did not affect the outcome. AbstractKeywords ► upper GI endoscopy ► gastroesophageal varices ► cirrhosis of liver